# itemDataValues

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  Delineation of the intimate details of the backbone conformation of pyridine nucleotide coenzymes in aqueous solution


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  PURPOSE

  A novel finite-element model of ventricular torsion for the analysis of the twisting behavior of the left human ventricle was developed, in order to investigate the influence of various biomechanical parameters on cardiac kinematics.


  METHODS

  The ventricle was simulated as a thick-walled ellipsoid composed of nine concentric layers. Arrays of reinforcement bars were embedded in each layer to mimic physiological myocardial anisotropy. The reinforcement bars were activated through an artificial combination of thermal and mechanical effects in order to obtain a contractile behavior which is similar to that of myocardial fibers. The presence of an incompressible fluid inside the ventricular cavity was also simulated and the ventricle was combined with simple lumped-parameter hydraulic circuits reproducing preload and afterload. Changes to a number of cardiac parameters, such as preload, afterload and fiber angle orientation were introduced, in order to study the effects of these changes on cardiac torsion.


  RESULTS

  The model is able to reproduce a similar torsional behavior to that of a physiological heart. The results of the simulations showed that there was sound correspondence between the model outcomes and available data from the literature. Results confirmed the importance of symmetric transmural patterns for fiber orientation.


  CONCLUSIONS

  This model represents an important step on the path towards unveiling the complexity of cardiac torsion. It proves to be a practical and versatile tool which could assist clinicians and researchers by providing them with easily-accessible, detailed data on cardiac kinematics for future diagnostic and surgical purposes.


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  In implantable medical devices (IMDs), the need of telemetry systems able to provide wireless bidirectional communication to interrogate and remotely program the device, as well as to monitor the physiological status of the patient, is growing. The object of the present study was to evaluate a new hermetic antenna for wireless short-range transmission system for IMDs which would assure reliable long-term functioning due to the high level of hermeticity of antenna's housing that limits the influence of body tissue environment on transmitted signals. Experimental tests were conducted on three different prototypes to evaluate the most efficient antenna configuration for transmission both in the air and through a mixture simulating the human thorax. Further tests were performed to assess the influence of electro-catheters connected to IMDs on transmitted signals. Results showed that the hermetic antenna guarantees a good wireless transmission both in the air and through the human thorax simulator. The results also show that the presence of an electro-catheter can influence the effective radiated power (ERP) transmitted depending on its position in relation to the telemetric circuitry. Both a controlled increase of the ERP without exceeding the limits imposed by rules and the optimization of the tuning between the antenna and the transmitter can assure a reliable short-range transmission (several meters) using the new hermetic antenna proposed.


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  United States Patent: 6620139 - Catheter system for performing intramyocardiac therapeutic treatment


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  http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=9&f=G&l=50&co1=AND&d=PTXT&s1=marcelli.INNM.&OS=IN/marcelli&RS=IN/marcelli


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  The multilumen catheter (2) is provided at one end with a needle system (9,
       9') formed by two or more single-lumen needles which are provided with
       respective discharge openings (110, 111) and which, via their longitudinal
       lumina (10, 11), are connected to corresponding lumina (3, 4) of the
       catheter for separate release of a tracer fluid for external image
       diagnostics systems and therapeutic fluids, for example DNA plasmids. The
       needles may be both straight or both helical or one of these needles may
       be straight and the other needle may be helical.


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  Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology


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  AIMS

  The aims of this study were first, to demonstrate that Peak Endocardial Acceleration during isovolumic systole (PEA I) is related to positive peak LVdP/dt, while Peak Endocardial Acceleration during isovolumic relaxation time (PEA II) is related to aortic diastolic pressure (ADP) and to negative peak LVdP/dt; and second, to test if the simultaneous recording of PEA I and PEA II offers a new chance to monitor indexes of LV systolic and diastolic function.


  METHODS

  An implantable haemodynamic monitor, based on PEA I and PEA II measurements via a microaccelerometer sensor located in the tip of a pacing lead, screwed into the right ventricle, was tested in nine sheep at baseline and during acute haemodynamic interventions: nitrate (0.1 mg/ kg), metaraminol (0.15 mg/kg), dobutamine (5 microg/kg) infusion. ADP, positive and negative peak LVdP/dt were simultaneously recorded by an aortic and left ventricular Millar catheter.


  RESULTS

  PEA I changes were significantly related to positive peak LVdP/dt changes during dobutamine induced inotropic changes (r = 0.83, P < 0.001). PEA II changes were significantly related to both ADP (r = 0.91, P < 0.001) and negative peak LVdP/dt changes (r = 0.92, P < 0.001) during nitrate induced hypotension and metaraminol induced hypertension.


  CONCLUSION

  The simultaneous recording of PEA I and PEA II with an implantable system offers a new chance to monitor indexes of LV systolic and diastolic function.


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  [State of the art and scientific evidence on the role of unidirectional airflow ventilation systems in reducing surgical site infections]


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  The use of unidirectional airflow ventilation systems in operating rooms is frequently recommended for the prevention of Surgical Site Infections (SSI). However, scientific evidence is lacking to clearly support this technology which entails high investment costs and operating expenses, as compared with traditional ventilation systems. This sparse evidence is mainly related to the small number of interventions analyzed in each study and the difficulty to distinguish the effects of ventilation and other important confounding factors, such as antibiotic prophylaxis, special operating staff clothing and adoption of educational and training programs against SSI for the surgical personnel. The different behavior of the industrialized countries towards this issue, as it comes out analyzing the existing Rules and Guidelines concerning operating rooms ventilation, reflects a precautionary approach towards a technology which, until recently, has clearly demonstrated neither benefits nor limitations. In 2008, a relevant scientific study was published, reporting results from 63 departments of 55 German hospitals for a total of 99.230 surgical interventions, in which a standardized SSI surveillance was performed. Unexpectedly, the study concluded that unidirectional airflow ventilation showed no benefit and was even associated with a significantly higher risk for severe SSI, as compared with turbulent clean air. The present review collects updates from the scientific literature and national and international Rules and Guidelines concerning the use of unidirectional airflow ventilation systems in operating rooms, analyzing all aspects involved in this issue, from the debated efficacy of these systems in reducing the incidence of SSI to the "side effects" associated to their use, as the relevant costs and the reduction of the environmental comfort for the operators.


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  An improved procedure of purification of serinesulfhydrase from chicken liver is described. Preparations of enzyme (700-fold purification with the yield of 40 per cent from total activity) have been obtained homogeneous on polyacrylamide gel electrophoresis. Molecular weight of serinesulfhydrase is 90.000; 1 mole of enzyme contains 2 moles of pyridoxalphosphate and consists apparently of 2 subunits. Amino acid composition of the enzyme is studied. Absorption spectrum of serinesulfhydrase has a maximum at 430 nm what is characteristic of numerous pyridoxal-P enzymes. The position of this maximum does not depend on pH (within its range 6--10) and the presence of L-serine, a primary enzyme substrate. An essential change in the absorption spectrum of enzyme was observed in the presence of some thiol compound--DL-homocysteine, beta-mercaptoethanol and glutathione (cosubstrates of the reaction) and L-cysteine (a primary reaction substrate). It is suggested that this change in the spectrum is due to the action of SH-compounds on the enzyme conformation before the beginning of the enzymatic reaction or on its initial stages.


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  Operator independent left ventricular function monitoring during pharmacological stress echo with the new peak transcutaneous acceleration signal


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  BACKGROUND

  As the myocardium contracts isometrically, it generates vibrations that can be measured with an accelerometer. The vibration peak, peak endocardial acceleration (PEA), is an index of contractility.


  OBJECTIVE

  To evaluate the feasibility of PEA measured by the cutaneous precordial application of the accelerometer sensor; and to assess the usefulness of PEA monitoring during pharmacological stress echocardiography.


  DESIGN

  Feasibility study.


  SETTING

  Stress echo laboratory.


  PATIENTS

  34 consecutive patients underwent pharmacological stress (26 with dipyridamole; 8 with dobutamine) and PEA monitoring simultaneously.


  INTERVENTIONS

  A microaccelerometer was positioned in the precordial region and PEA was recorded. Dipyridamole was infused up to 0.84 mg/kg in 10 minutes, and dobutamine up to 40 microg/kg/min in 15 minutes.


  RESULTS

  A consistent PEA signal was obtained in all patients. Overall mean (SD) baseline PEA was 0.26 (0.15) g (g = 9.8 m/s(2)), increasing to 0.5 (0.36) g at peak stress (+0.24 g, 95% confidence interval (CI) 0.14 to 0.34 g; p < 0.01). PEA increased from 0.26 (0.16) to 0.37 (0.25) g in the dipyridamole group (+0.11 g, 95% CI 0.08 to 0.16 g; p < 0.01), and from 0.29 (0.1) to 0.93 (0.37) g in the dobutamine group (+0.64 g, 95% CI 0.37 to 0.91 g; p < 0.01).


  CONCLUSIONS

  Using precordial leads this method offers potential for diagnostic application in the short term monitoring of myocardial function. PEA monitoring is feasible during pharmacological stress and documents left ventricular inotropic response quantitatively in a non-invasive and operator independent fashion.


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  To quantify cardiac apex rotation (CAR), the authors recently proposed the use of a Coriolis force sensor (gyroscope) as an alternative to other complex techniques. The aim of this study was to evaluate the effects of right ventricular (RV) pacing on CAR. A sheep heart was initially paced from the right atrium to induce a normal activation sequence at a fixed heart rate (AAI mode) and then an atrioventricular pacing was performed (DOO mode, AV delay = 60 ms). A small gyroscope was epicardially glued on the cardiac apex to measure the angular velocity (Ang V). From AAI to DOO pacing mode, an increase (+9.2%, p < 0.05) of the maximum systolic twisting velocity (Ang VMAX) and a marked decrease (-19.9%, p < 0.05) of the maximum diastolic untwisting velocity (Ang VMIN) resulted. RV pacing had negligible effects (-3.1%, p = 0.09) on the maximum angle of CAR, obtained by integrating Ang V. The hemodynamic parameters of systolic (LVdP/dtMAX) and diastolic (LVdP/dtMIN) cardiac function showed slight variations (-3.8%, p < 0.05 and +3.9%, p < 0.05, respectively). Results suggest that cardiac dyssynchrony induced by RV pacing can alter the normal physiological ventricular twist patterns, particularly affecting diastolic untwisting velocity.


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  Previous studies demonstrated that peak endocardial acceleration (PEA) in sinus rhythm is related to LV dP/dtmax. Until now, PEA was never evaluated during R-R interval variations in AF. The aim of this study was to establish the behavior of PEA in AF and the relationship of PEA versus LV dP/dtmax. Six sheep (65 +/- 6 kg) were instrumented with a LV Millar catheter and with an accelerometer lead. AF was induced and PEA, LV dP/dtmax, and ECG were monitored. AF persisted for 5 +/- 1.3 minutes. From sinus rhythm to AF, the heart rate went from 92 +/- 3 to 130 +/- 35 beats/min (P < 0.05), LV dP/dtmax from 684 +/- 18 to 956 +/- 344 mmHg/s (P = NS) and PEA from 0.82 +/- 0.06 to 0.94 +/- 0.33 g (P = NS). The correlation between PEA and LV dP/dtmax was significative in sinus rhythm (r = 0.7, P < 0.05) and in AF (r = 0.8, P < 0.05). A positive relationship was found between the preceding interval and PEA (r = 0.4 +/- 0.07, P < 0.05) and LV dP/dtmax (r = 0.61 +/- 0.08, P < 0.05), while a negative one was found between the prepreceding interval and both PEA (r = -0.39 +/- 0.11, P < 0.05) and LV dP/dtmax (r = -0.64 +/- 0.05, P < 0.05). At the onset of AF, LV dP/dtmax and PEA showed similar changes: beat-to-beat correlation between PEA and LV dP/dtmax was high. As for LV dP/dtmax, PEA is positively related to the preceding interval and negatively related to the prepreceding interval. These data confirm that PEA reflects heart contractility also during AF and hold promise for the use of this sensor in therapeutic implantable devices.


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  [Cost evaluation of a ventilation system for operating theatre: an ultraclean design versus a conventional one]


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  The postoperative infection has been recognized as a critical problem in healthcare, increasing patients'complications and hospitalization costs. At the moment the scientific evidence clearly linking ventilation parameters, such as air changes per hour, bacterial counts and infection, is lacking, with the exception of prosthetic joint surgery. This study aims to evaluate the building and operating costs of an ultraclean system versus a conventional one (which satisfies the minimum performance requested by rules), also considering the debating efficacy of ultraclean ventilation on prevention of postoperative infection. The results of our study show an increase of 24% in the building costs and of 34% in the annual operating costs for the ultraclean system versus the conventional one. The estimated 24% increase of the building costs for the ultraclean ventilation system represents only a 5% increase if compared to the total cost of a not equipped operating theatre. Therefore, the increase on costs linked to the use of high performance ventilation facilities seems to be so small that overcoming current rules towards ultraclean systems could be acceptable.


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  Initial experience with a telerobotic system to remotely navigate and automatically reposition standard steerable EP catheters


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  The use of robotic systems in cardiac interventional procedures is growing. The insertion and maneuvering in the human body of electrophysiology (EP) catheters is currently carried out manually under fluoroscopic guidance, resulting in operator fatigue and prolonged x-ray exposure. We report our initial animal experience with a novel telerobotic system (TS) to remotely navigate and automatically reposition standard steerable EP catheters within the heart. We developed a TS able to guide, as a "robotic hand," EP catheters without the need of dedicated catheters and cumbersome devices. During tests on three sheep, catheter navigation and repositioning to 12 predefined endocardial targets were previously performed by conventional manual procedure and then using the TS implemented with an automatic catheter repositioning function. All the predefined targets were reached under fluoroscopy visualization, and procedural times were measured during catheter navigation and repositioning. The use of the TS slightly reduced the time necessary for catheter navigation compared with the conventional manual procedure (13.0 +/- 5.6 vs 16.1 +/- 6.4 seconds, p < 0.001) and significantly decreased the time for a precise catheter repositioning (9.2 +/- 2.5 vs 17.8 +/- 7.1 sec, p < 0.001). The TS proved to be a promising tool for remote navigation of standard EP catheters reducing the time necessary for catheter repositioning.


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  Validation of a peak endocardial acceleration-based algorithm to optimize cardiac resynchronization: early clinical results


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  AIMS

  Cardiac resynchronization therapy (CRT) involves time-consuming procedures to achieve an optimal programming of the system, at implant as well as during follow-up, when remodelling occurs. A device equipped with an implantable sensor able to measure peak endocardial acceleration (PEA) has been recently developed to monitor cardiac function and to guide CRT programming. During scanning of the atrioventricular delay (AVD), PEA reflects both left ventricle (LV) contractility (LV dP/dt(max)) and transmitral flow. A new CRT optimization algorithm, based on recording of PEA (PEA(area) method) was developed, and compared with measurements of LV dP/dt(max), to identify an optimal CRT configuration.


  METHODS AND RESULTS

  We studied 15 patients in New York Heart Association classes II-IV and with a QRS duration >130 ms, who had undergone implantation of a biventricular (BiV) pulse generator connected to a right ventricular (RV) PEA sensor. At a mean of 39 +/- 15 days after implantation of the CRT system, the patients underwent cardiac catheterization. During single-chamber LV or during BiV stimulation, with initial RV or LV stimulation, and at settings of interventricular intervals between 0 and 40 ms, the AVD was scanned between 60 and 220 ms, while LV dP/dt(max) and PEA were measured. The area of PEA curve (PEA(area) method) was estimated as the average of PEA values measured during AVD scanning. A >or=10% increase in LV dP/dt(max) was observed in 12 of 15 patients (80%), who were classified as responders to CRT. In nine of 12 responders (75%), the optimal pacing configuration identified by the PEA(area) method was associated with the greatest LV dP/dt(max).


  CONCLUSION

  The concordance of the PEA(area) method with measurements of LV dP/dt(max) suggests that this new, operator-independent algorithm is a reliable means of CRT optimization.


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  The health-care facility environment is involved in disease transmission in essentially two different situations: 1. in cases where patients are immunocompromised and require protection from infections; 2. in cases of inadvertent exposure to environmental or airborne pathogens that can aggravate patients' existent disease and cause illness among health-care personnel. Environmental infection-control strategies and engineering controls can effectively prevent transmission of these infections. In particular the ventilation system is fundamental to the control of the concentration of airborne contaminants within a hospital isolation room because it establishes and maintains appropriate pressure differentials within special care areas of the building. Thus the incidence of health-care-associated infections can be minimized by adherence to ventilation standards suggested in the guidelines for specialized care environments such as Airborne Infection Isolation rooms (AII, as in situation 2 above), and Protective Environments (PE) rooms (as in situation 1 above). This report is a comparative review of the principal guidelines and strategies existing in the international scientific literature for the prevention of environment-associated infections in healthcare facilities using pressure differentials (positive pressure for PE rooms, negative pressure for AII rooms). The purpose of the review is also to investigate the state-of-the-art use of the "alternative pressure rooms", i.e., areas furnished with a ventilation system capable of switching pressure from positive to negative according to patients' needs. The results of the present analysis indicate an unenthusiastic reaction to these "alternative pressure rooms", although there is no scientific evidence against their use.


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  BACKGROUND

  Neutrophils are the predominant phagocytes in the early stages of myocardial ischemia-reperfusion response and are also implicated in the development of tissue damage. This study examined the role of recruited macrophages in the evolution of this tissue injury.


  METHODS

  Farm pigs were subjected to 30 minutes of myocardial ischemia followed by 30 minutes of reperfusion. Biopsy samples were taken from the control, ischemic, and ischemic-reperfused left ventricle wall and processed for both morphologic and biochemical analyses. In situ production of tumor necrosis factor-alpha was evaluated by Western blot and immunofluorescence. A full hemodynamic evaluation was also performed.


  RESULTS

  Myocardial ischemia and early reperfusion caused marked neutrophil and macrophage tissue accumulation and tumor necrosis factor-alpha production by the injured tissue. Immunofluorescence studies allowed us to localize tumor necrosis factor-alpha predominantly in tissue-infiltrating macrophages. No depression in the global myocardial contractile function was observed, either during ischemia or after reperfusion.


  CONCLUSIONS

  These data suggest that the newly recruited macrophages within the ischemic and early post-ischemic myocardium may play a role in promoting neutrophil tissue infiltration and subsequent neutrophil-induced tissue dysfunction by producing tumor necrosis factor-alpha.


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  Aim of this study is to develop a mechanical simulator (MS) reproducing cardiac wall kinematics [i.e., radial (R), longitudinal (L) and rotational (RT) motions] to test piezoelectric gyroscopic sensors (GS) that are able to measure cardiac torsion that has proved to be a sensitive index of cardiac performance. The MS consists of three brushless motors controlled by a dedicated software either separately or simultaneously reproducing the three main cardiac wall movements (R, L, RT) obtained by implementing different physiologic or pathologic velocity profiles derived from in vivo data. GS accuracy (max % error) was experimentally tested by connecting it to the MS driven in velocity in different working conditions [i.e., cardiac period (515-1030 ms), RT angle (4-16 degrees), GS axis inclination (0-90 degrees) with respect to the cardiac rotation axis]. The MS reproduced the tested velocity profiles well. The GS showed high accuracy in measuring both physiologic and pathologic RT velocity profiles, whereas they proved insensitive to R and L motions. GS axis inclination influenced measurements; however, it was possible to correct this taking the inclination angle cosine into account. The MS proved to be a useful tool to study cardiac wall kinematics and test GS reliability with a view to in vivo application.


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  Cardiac apex rotation, quantified by sophisticated techniques (radiopaque markers and tagged magnetic resonance), has been shown to provide a sensitive index of left ventricle (LV) dynamics. The authors describe the first experimental assessment of cardiac apex rotation using a gyroscopic sensor based on Coriolis force, epicardially glued on the apex. Dynamics of apex rotation were evaluated in a sheep at baseline, after a positive inotropic drug infusion, and after impairment of cardiac function induced by coronary ligation. To evaluate the efficacy of the sensor to monitor cardiac function, results were compared to contractility variations expressed by the maximum value of the first derivative of LV pressure (LVdP/dtMAX). After inotropic drug infusion, a parallel increasing trend resulted for LVdP/dtMAX, for the maximum value of angular velocity measured by the sensor, and for apex rotation angle derived from velocity signal (+146%, +155%, and +11% from baseline, respectively), whereas a decreasing trend of all three parameters resulted after coronary ligation (-35%, -31%, and -65%). The twist pattern also was altered from baseline. These initial results suggest that the use of an implantable rotation sensor based on Coriolis force can be an efficient and effective tool to assess LV torsional deformation both in normal and failing hearts.


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  http://journals.lww.com/asaiojournal/Fulltext/2005/11000/First_Experimental_Evaluation_of_Cardiac_Apex.18.aspx


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  Cardiac apex rotation, quantified by sophisticated techniques (radiopaque markers and tagged magnetic resonance), has been shown to provide a sensitive index of left ventricle (LV) dynamics. The authors describe the first experimental assessment of cardiac apex rotation using a gyroscopic sensor ...


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  http://journals.lww.com/asaiojournal/Abstract/2005/11000/First_Experimental_Evaluation_of_Cardiac_Apex.18.aspx


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  http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=5&f=G&l=50&co1=AND&d=PTXT&s1=marcelli.INNM.&OS=IN/marcelli&RS=IN/marcelli


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  United States Patent: 7664547 - Active implantable medical device with biventricular pacing and automatic optimization of pacing configuration


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  An active implantable medical device with biventricular pacing and
       automatic optimization of pacing configuration. The device collects and
       analyzes an endocardial acceleration signal (EA), and searches for an
       optimal pacing configuration based upon a performance index derived from
       at least one value relating to one and/or the other of the two
       endocardial acceleration peaks (PEA I, PEA II) over a given heart cycle.
       Optimization search operates through a scanning of a parameter, e.g.,
       atrio-ventricular delay, and calculation of the surface area underneath
       the characteristic of the peak amplitude as a function of the scanned
       parameter (atrioventricular delay).


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  [NOTICE – Transcatheter aortic valve implantation: Evaluation of the evidence and synthesis of organizational issues]


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  The incidence and natural history of type I and II endoleak: A 5-year follow-up assessment with 1 color duplex ultrasound scan


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  The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment with... - Abstract - Europe PubMed Central


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  Type II lumbar endoleaks: Hemodynamic differentiation by contrast-enhanced ultrasound scanning and influence on aneurysm enlargement after endovascular aneurysm repair


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  Objective 
  The objective of this study was to differentiate type II lumbar endoleaks on the basis of dynamic features identified by contrast-enhanced ultrasound scanning (CUS) and to evaluate the role of this differentiation in detecting abdominal aortic aneurysm (AAA) enlargement ≥1 mL/mo. 
  Methods 
  Eighteen male patients (mean age, 71.8 years) with type II lumbar endoleak suspected at CUS underwent computed tomography angiography (CTA) and digital subtraction angiography (DSA). On CTA, AAA volumes and endoleak visualization and volume were assessed. At CUS, performed after a bolus of 1.5 to 2.4 mL of a second generation blood pool contrast agent, the following parameters were evaluated: presence of contrast material within the aneurysmal sac (endoleak), delay of endoleak detection (wash-in) and disappearance (washout) from the beginning of contrast injection, visualization of inflow and outflow vessels, and presence of cavity filling. Statistical analysis was performed regarding endoleak features at CUS, endoleak detection at CTA, and rate of AAA enlargement. 
  Results 
  DSA confirmed all the endoleaks. Mean ± standard deviation wash-in and washout times were 121.9 ± 132.6 and 337.2 ± 193.7 seconds, respectively; a significant relation was observed between these two parameters (P &lt; .01, analysis of variance). By Youden plots, endoleaks were classified as hyperdynamic when wash-in was &lt;100 seconds (n = 10, 55.5%) and/or washout was &lt;520 seconds (n = 13, 72.2%). A slower washout was associated with nonvisualized outflow (66.7%) and/or inflow arteries (66.7%) (P &lt; .05). Eight endoleaks (44.4%) were missed at CTA; it occurred in hypodynamic endoleaks, absence of detectable inflow or outflow vessels, and absence of cavity filling at CUS (P &lt; .05). Overall mean AAA volume increase rate was 1.1 ± 1.7 mL/mo. By multiple logistic regression model, the washout time ≥520 seconds was the only independent predictor of AAA volume increase ≥1 mL/mo (8 patients, 44.4%). 
  Conclusion 
  Type II lumbar endoleaks show different hemodynamic features at CUS, which might influence the rate of aneurysm enlargement, addressing the need for treatment.


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  http://pdn.sciencedirect.com/science?_ob=MiamiImageURL&_cid=272610&_user=606145&_pii=S0741521404013692&_check=y&_origin=article&_zone=toolbar&_coverDate=31-Jan-2005&view=c&originContentFamily=serial&wchp=dGLbVlV-zSkWA&md5=50f966ad201145a91f0b42691fb60734&pid=1-s2.0-S0741521404013692-main.pdf


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  Imaging Techniques for Detection and Management of Endoleaks after Endovascular Aortic Aneurysm Repair1


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  Endovascular aortic aneurysm repair (EVAR) is evolving into a viable alternative to open surgical repair for many patients with abdominal and thoracic aortic aneurysms. Endoleak development is a complication of EVAR and represents one of the limitations of this procedure. Endoleaks represent blood flow outside the stent-graft lumen but within the aneurysm sac. Lifelong imaging surveillance of patients after EVAR is critical to detect endoleaks for the patient's benefit and to determine the long-term performance of the stent-graft. Although computed tomographic angiography is the most commonly used examination for imaging surveillance, magnetic resonance angiography, ultrasonography, and digital subtraction angiography all have a role in endoleak detection and management. This review will focus on imaging techniques used for endoleak detection and the role imaging surveillance plays in the overall care of the post-EVAR patient.
  © RSNA, 2007


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  http://www.chuliege-imaa.be/archives_2010/liege-backup2010/pdf/presentations_2010/saturday_11.20_labropoulos.pdf


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  Duplex ultrasound factors predicting persistent type II endoleak and increasing AAA sac diameter after EVAR


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  OBJECTIVE

  While the significance of type II endoleaks (T2ELs) on the long-term outcome of endovascular abdominal aneurysm repair (EVAR) to repair abdominal aortic aneurysms (AAAs) is debatable, duplex ultrasonography (DU) parameters have been suggested to be predictive of their closure or persistence. The purpose of this study was to determine which, if any, of these variables was associated with persistent T2EL or increased AAA sac diameter.


  METHODS

  Between 1998 and 2009, 278 patients underwent EVAR and post-operative DU surveillance during long-term follow-up (1-11 years) in our accredited non-invasive vascular laboratory by one of three experienced technologists. DU measured intra-sac flow velocity (IFV), spectral doppler waveform (SDW) patterns, post-EVAR sac diameter, and number of T2ELs.


  RESULTS

  T2ELs developed in 14% (38/278) of patients post-EVAR. Fourteen patients had T2ELs that resolved, and sac diameter decreased or remained the same: the average IFV was 42 cm/second; SDW patterns were monophasic in five, biphasic in seven and bidirectional in two; and multiple T2ELs were not present (0%) in any patient. Twelve patients had T2ELs that persisted, but sac diameter decreased or remained the same: the average IFV was 47 cm/second; SDW patterns were monophasic in one, biphasic in five, bidirectional in five, and undetermined in one; and multiple T2ELs were found in 17% (2) of patients. Twelve patients had T2ELs that persisted and were associated with increased sac diameter: the average IFV was 43 cm/second, SDW patterns were monophasic in one, biphasic in two, and bidirectional in nine; and multiple T2ELs were identified in 75% (9) of patients. None of the 38 patients with T2ELs treated with selective surgical or endovascular intervention for enlarging sac diameters (11/12) experienced a ruptured aneurysm.


  CONCLUSION

  Contrary to previous smaller reports of T2ELs and DU surveillance, parameters such as IFV did not correlate with increased post-EVAR sac diameter. The presence of multiple T2ELs and bidirectional SDW may be the strongest factors predictive of increased sac diameter.


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  Growing concerns regarding radiation exposure, contrast induced nephropathy and increasing costs lead us to reconsider the necessity of CTA for all EVAR patients. The purpose of this study is to compare the results of different follow-up imaging modalities with the aim of finding a rationale to the optimal follow-up imaging protocol. We reviewed recent literature regarding post EVAR imaging modalities and compared it to our experience with different follow-up protocols. Modalities compared were CTA, DUS, CEUS, and plain abdominal X-ray with regard to detection of complications, cost, overall impact to the patient, and on decision making regarding reintervention. CTA is related to increased follow-up costs and a much higher exposure to radiation compared to other modalities. The cumulative radiation dose can have a significant impact on the attributable lifetime cancer risk of patients. Renal function deterioration during post EVAR follow-up is higher compared to open repair. Plain abdominal X-ray is the best manageable modality and a well established tool in documenting migration kinking and stent fracture. Plain X-Ray cannot be used as a standalone imaging modality since it doesn't allow direct detection of endoleaks. As far as detection of endoleaks is concerned recent meta-analyses show a sensitivity of 66-77% for DUS and 81-98% for CEUS, respectively. Most endoleaks missed by DUS and CEUS are type II endoleaks with no need for reintervention. Our data in a cohort of 62 patients do show a sensitivity of 66.7% for DUS, and do correlate with current literature. No endoleaks requiring reintervention were missed. A follow-up protocol comprising of DUS/CEUS and plain abdominal X-ray gives a wide range of information covering EVAR related risks and is associated with less radiation exposure, avoidance of renal function deterioration due to repeated contrast agent application and an important decrease in the cost of EVAR follow-up. CTA should be reserved for cases of inconclusive ultrasound, signs of complications and unfavourable anatomy.


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  Contrast ultrasound imaging: the best method to detect type II endoleak during endovascular aneurysm repair follow-up


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  Objective: Type II endoleak is the most common complication after endovascular aneurysm repair and require close surveillance. Hence, the need to validate new techniques as alternative to helical CT-scan, the reference standard. The aim of this study is to evaluate the efficacy of Cadence Contrast Pulse Sequencing ultrasound technique with second generation contrast agents in detecting endoleaks, and to compare the results with data obtained from CTA. Methods: 30 patients with endovascular stent grafts, during their regular follow-up consisting in serial CT and ultrasound exams performed at discharge, at one and six months and at one year thereafter, previous informed consent, were enrolled in a prospectic double blind study design in order to compare triphasic helical CT-scan to another adjunctive ultrasound investigation (Cadence CPS technique with Sono Vue). No more than 15 days occurred between the two examinations. In the study were evaluated only data obtained from the comparison of the two concomitant investigations, independently from the follow-up. Variables analysed were changes in the maximum diameter of the aneurysmal sac, presence and type of endoleak, if detected. In the case of disagreement between the two diagnostic tools angiography was performed. Results: One patient dropped out because of violation of the study protocol (a stroke occurred in the time interval between the two investigations). Both exams visualised patency and proper graft placement in all the remaining patients. Aneurysmal diameters with both investigations overlapped (rs:0.98). In 21 patients no endoleak was detected with a significant aneurysmal sac shrinkage (P<0.001). In seven patients both methods confirmed presence of endoleak. Ultrasonography detected all type of endoleaks, while CT-scan was uncertain in one. Moreover, in one patient CT-angiography showed an increased aneurysmal diameter without other evidence, while a contrast ultrasound investigation disclosed a type II low-flow endoleak, confirmed by angiography. Conclusions: The Cadence Contrast Pulse Sequencing with echo contrast agent is an ultrasound technique that substantially improves the ultrasound diagnostic reliability.


value:
  Evaluation of Potential Outcome Predictors in Type II Endoleak: A Retrospective Study With CT Angiography Feature Analysis


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  OBJECTIVE. The purpose of this study is to investigate which CT features of type II endoleaks following abdominal aortic aneurysm (AAA) endoluminal stent-graft repair can be used to predict clinical outcome.
  MATERIALS AND METHODS. We retrospectively identified 59 patients with type II endoleak after endovascular repair of an AAA with CT of the abdomen and pelvis. Patients were stratified into two groups: those who did (n = 23) and those who did not (n = 35) require reintervention. CT characteristics of type II endoleaks were recorded and correlated with the clinical outcome.
  RESULTS. The CT features showing the strongest association with the clinical outcome were the transverse diameter of the endoleak cavity (mean, 1.13 cm in the nonreintervention group vs 1.85 cm in the reintervention group; p = 0.007) and the maximum diameter of the vessel communicating with the endoleak (0.34 vs 0.40 cm; p = 0.046). The transverse diameter of the endoleak cavity on arterial phase imaging had the greatest predictive capability, with an area under the receiver operating characteristic curve of 0.74. A transverse diameter greater than 1.42 cm had a positive predictive value of 0.71 and a negative predictive value of 0.82. The anteroposterior diameter, location, and heterogeneity of the endoleak cavity and the number of patent communicating vessels did not correlate well with clinical outcome. The correlation between endoleak cavity measurements and clinical outcome was independent of the aneurysm size.
  CONCLUSION. There are identifiable CT features associated with the clinical outcome of patients with type II endoleak that have moderate predictive capabilities.


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  Evaluation of abdominal aortic aneurysm after endovascular repair: prospective validation of contrast-enhanced US with a second-generation US contrast agent


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  PURPOSE

  To prospectively assess the accuracy of contrast agent-enhanced (CE) ultrasonography (US) with a second-generation US contrast agent in the detection and classification of endoleaks after endovascular repair of abdominal aortic aneurysms (EVAR), with computed tomographic (CT) angiography as the reference standard.


  MATERIALS AND METHODS

  Institutional review board and written informed consent were obtained. Thirty-five patients who underwent EVAR were enrolled in a prospective study that consisted of CT angiography and CE US studies performed at 1- and 6-month follow-up and performed yearly thereafter. CE US was performed after bolus injection of 2.4 mL of sulfur hexafluoride by using equipment with specific software for contrast studies. Angiography was performed in patients who had type II endoleaks with an increase in aneurysm sac size and in patients with type I or III endoleaks. CE US sensitivity, specificity, positive and negative predictive values, and accuracy were determined for endoleak detection, and Cohen κ statistic was used to assess agreement of CE US and CT angiographic findings for endoleak classification.


  RESULTS

  A total of 126 CT angiographic and CE US studies were performed. CT angiography depicted 34 endoleaks in 16 patients (type IA, n=1; type IB, n=1; type II inferior mesenteric artery, n=2; type II lumbar artery, n=28; type II complex, inferior mesenteric, and lumbar arteries, n=2). CE US depicted 33 endoleaks. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CE US in endoleak detection were 97%, 100%, 100%, 98%, and 99%, respectively. CE US enabled correct classification of 26 of 33 endoleaks. No clinically important endoleak was missed at CE US.


  CONCLUSION

  CE US yields good sensitivity, specificity, and accuracy in endoleak detection, and it might represent a noninvasive tool that can be used in the follow-up of patients who undergo EVAR.


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  PURPOSE

  To evaluate whether the image fusion with contrast enhanced ultrasound (CEUS) and CT affects the diagnosis of endoleaks in unclear cases.


  METHODS AND MATERIALS

  35 patients with follow-up examinations after endovascular aneurysm repair (EVAR) were included in this retrospective study. Mean patient age was 73 years (range 54-83 y). B-scan, colour doppler and CEUS (1.2 ml SonoVue®, Bracco Imaging Germany) were performed in all patients by an experienced examiner using two different high-end ultrasound system (Siemens ACUSON S2000™, Siemens Healthcare, Erlangen, Germany or Logic E9, GE Healthcare, Milwaukee,WI, USA) with a multifrequency curved array transducer. The examiner was initially blinded to the CT results. Additional image fusion with CT-angiography (CTA) was then performed. The ultrasound examinations were later read by two blinded unbiased investigators with more than five years of clinical ultrasound in consensus.


  RESULTS

  All patients were examined using all diagnostic ultrasound tools of the study. The results show that image fusion is easy and convenient to perform. Conventional ultrasound examination with B-scan and colour Doppler examination detected one Type I and one Type II endoleak, contrast enhanced ultrasound detected one Type I and three Type II endoleaks after EVAR whereas CTA depicted one Type I and two Type II endoleaks. Ultrasound image fusion with CT-angiography confirmed one Type I and three Type II endoleaks.


  CONCLUSION

  In comparison to conventional ultrasound and CTA the use of CEUS improved the visualization and classification of endoleaks. CEUS shows even small blood flow which can be depicted due to the real time imaging of endoleaks. In unclear cases additional ultrasound image fusion with CEUS and CT angiography improves the visualisation of small endoleaks and this may cause a change in the follow-up interval. CEUS is a good alternative to CT in the detection and follow-up of endoleaks, especially in patients with contraindications to CT contrast agents due to allergies or renal failure, enabling reduced additional costs and exposure to radiation.


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  Prospective comparative analysis of colour-Doppler ultrasound, contrast-enhanced ultrasound, computed tomography and magnetic resonance in detecting endoleak after endovascular abdominal aortic aneurysm repair


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  European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery


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  OBJECTIVES

  To assess the accuracy of colour-Doppler ultrasound (CDUS), contrast-enhanced ultrasonography (CEUS), computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in detecting endoleaks after endovascular abdominal aortic aneurysm repair (EVAR).


  DESIGN

  Prospective, observational study.


  MATERIALS AND METHODS

  From December 2007 to April 2009, 108 consecutive patients who underwent EVAR were evaluated with CDUS, CEUS, CTA and MRA as well as angiography, if further treatment was necessary. Sensitivity, specificity, accuracy and negative predictive value of ultrasound examinations were compared with CTA and MRA as the reference standards, or with angiography when available.


  RESULTS

  Twenty-four endoleaks (22%, type II: 22 cases, type III: two cases) were documented. Sensitivity and specificity of CDUS, CEUS, CTA, and MRA were 58% and 93%, 96% and 100%, 83% and 100% and 96% and 100% respectively. CEUS allowed better classification of endoleaks in 10, two and one patients compared with CDUS, CTA and MRA, respectively.


  CONCLUSIONS

  The accuracy of CEUS in detecting endoleaks after EVAR is markedly better than CDUS and is similar to CTA and MRA. CEUS seems to be a feasible tool in the long-term surveillance after EVAR, and it may better classify endoleaks missed by other imaging techniques.


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  This study presents the first quantification and visualization of secondary flow patterns with vector flow ultrasound. The first commercial implementation of the vector flow method Transverse Oscillation was used to obtain in-vivo, 2D vector fields in real-time. The hypothesis of this study was that the rotational direction is constant within each artery. Three data sets of 10 seconds were obtained from three main arteries in healthy volunteers. For each data set the rotational flow patterns were identified during diastole. Each data set contains a 2D vector field over time using the vector angles and velocity magnitudes the blood flow patterns were visualized using streamlines in Matlab (Mathworks, Natick, MA, USA). The rotational flow was quantified by the angular frequency for each cardiac cycle, and the mean rotational frequencies and standard deviations were calculated for the abdominal aorta -1.3 #x00B1;0.4;-1.0 #x00B1;0.3;-0.9 #x00B1;0.2Hz, the common iliac artery -0.4 #x00B1;0.1;-1.0 #x00B1;0.2;-0.4 #x00B1;0.1Hz, and the common carotid artery 0.8 #x00B1;0.3;1.4 #x00B1;0.3;0.4 #x00B1;0.1Hz. A positive sign indicates an anti-clockwise rotation, and a negative sign indicates clockwise rotation. The sign of the rotational directions within each artery were constant.


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  http://ieeexplore.ieee.org/xpl/articleDetails.jsp?tp=&arnumber=6293240&contentType=Conference+Publications&searchField%3DSearch_All%26queryText%3Dultrasound+flow+imaging+matlab


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  Volumetric contrast-enhanced ultrasound for characterizing tumor vascularity: Preliminary studies in an animal model


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  This paper describes a volumetric strategy for characterization of tumor blood flow using microbubble (MB) contrast agents and ultrasound (US) imaging. Volumetric contrast-enhanced US (VCEUS) imaging was implemented on a SONIX RP US system (Ultrasonix Medical Corp) equipped with a broadband 4DL14-5/38 probe. Acquisition of VCEUS data was achieved at a volume rate of 1 Hz using a MB sensitive harmonic imaging mode. Following MB infusion, custom Matlab programs were used to compute MB time-intensity curve-specific parameters: blood volume (IPK), transit time (T1/2PK), flow rate (SPK), and tumor perfusion (AUC). Using a xenograft model of human breast cancer, it is shown that millimeter-sized deviations in transducer positioning can have profound implications on US-based blood flow estimators with errors ranging from 6.4 to 40.3% and dependent on both degree of misalignment and particular blood flow estimator. These errors indicate that VCEUS imaging should be considered in tumor analyses because they incorporate the entire mass and not just a representative planar cross-section.


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  http://ieeexplore.ieee.org/xpl/articleDetails.jsp?tp=&arnumber=6293598&contentType=Conference+Publications&searchField%3DSearch_All%26queryText%3Dultrasound+flow+imaging+matlab


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  To improve the resolution of contrast-assisted imaging systems, we previously developed a 25-MHz microbubbles-destruction/replenishment imaging system with a spatial resolution of 160 X 160 mum. The goal of the present study was to propose a new approach for functionally evaluating the microvascular volumetric blood flow based on this high-frequency, ultrasound imaging system. The approach includes locating the perfusion area and estimating the blood flow velocity therein. Because the correlation changes between before and after microbubble destruction in two adjacent images, a correlated-based approach was introduced to detect the blood perfusion area. We also have derived a new sigmoid-based model for characterizing the microbubbles replenishment process. Two parameters derived from the sigmoid-based model - the rate constant and inflection time - were adopted to evaluate the blood flow velocity. This model was validated using both simulations and in vitro experiments for mean flow velocities ranging from 1 to 10 mm/s, which showed that the model was in good agreement with simulated and measured microbubble-replenishment time-intensity curves. The results indicate that the actual flow velocity is highly correlated with the estimates of the rate constant and the reciprocal of the inflection time. B-mode imaging experiments for mean flow velocities ranging from 0.4 to 2.1 mm/s were used to assess the volumetric flow in the microcirculation. The results indicated the high correlation between the actual volumetric flow rate and the product of the estimated perfusion area and rate constant, and the reciprocal of the inflection time. We also found that the boundary of the microbubble destruction volume significantly affected estimations of the flow velocity. The perfusion area can be located, and the corresponding flow velocity can be estimated simultaneously in a one-stage, microbubble-destruction/replenishment process, which makes the assessment of the volumetric bloo- - d flow in the microcirculation feasible using a real-time, high-frequency ultrasound system.


value:
  http://ieeexplore.ieee.org/xpl/articleDetails.jsp?tp=&arnumber=4454304&contentType=Journals+%26+Magazines&searchField%3DSearch_All%26queryText%3Dultrasound+flow+imaging+processing


value:
  This video presents an example of the use of "PulsatileFlow toolbox v2.0" and "FlowImageProcessing toolbox v2.0" of matlab for studying blood flow in arteries. The example follows the process below:
   
  1- To simulate pulsatile flow in an artery of radius = 0.08 cm and to generate dicom images using "PulsatileFlow toolbox v2.0" (Other parameters of the flow condition are set by the default values of toolbox). The resulted dicom images are stored in folder "artery" in the same address as the toolbox.

  2- To load the dicom images using the setting generated by the dicom simulator in "FlowImageProcessing toolbox v2.0". The segmentation algorithm is applied to compute the flow image characteristics such as velocity, flow rate and wall shear stress.

  3- It is possible to compare the analytical data for velocity, flow rate and wall shear stress in the "PulsatileFlow toolbox" and processed data in the "FlowImageProcessing toolbox" resulted from images.


value:
  A simple algorithm for angle independent motion imaging is described. This method requires only one absolute difference operation per pixel, compared to eight operations for normalized cross correlation. Quantitative studies using speckle-generating targets translated by fixed amounts both axially and laterally indicate that the technique tracks moving speckle as accurately as correlation. Color flow images generated from clinical blood and liver data highlight the success of the technique for tracking both large and small motions in two dimensions. The algorithm's suitability for implementation in digital hardware makes possible the development of clinical instruments for angle independent ultrasonic imaging of blood flow and tissue motion in real time.


value:
  Can echocardiographic particle image velocimetry correctly detect motion patterns as they occur in blood inside heart chambers? A validation study using moving phantoms


value:
  Can echocardiographic particle image velocimetry correctly detect motion patterns as they occur in blood inside heart chambers?


value:
  http://www.101seminartopics.com/wp-content/uploads/2009/07/34IMPLEMENTATION-OF-ZOOM-FFT-IN-ULTRASONIC-BLOOD-FLOW-A.pdf


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  This paper proposes two novel iterative data-adaptive spectral estimation techniques for blood velocity estimation using medical ultrasound scanners. The techniques make no assumption on the sampling pattern of the emissions or the depth samples, allowing for duplex mode transmissions where B-mode images are interleaved with the Doppler emissions. Furthermore, the techniques are shown, using both simplified and more realistic Field II simulations as well as in vivo data, to outperform current state-of-the-art techniques, allowing for accurate estimation of the blood velocity spectrum using only 30% of the transmissions, thereby allowing for the examination of two separate vessel regions while retaining an adequate updating rate of the B-mode images. In addition, the proposed methods also allow for more flexible transmission patterns, as well as exhibit fewer spectral artifacts as compared to earlier techniques.


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  Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS). A pictorial comparison with CTA


value:
  In this paper, a case study of in-vivo blood vector velocity images of the carotid artery are presented. The transverse oscillation (TO) method for blood vector velocity estimation has been used to estimate the vector velocities. The carotid arteries of three healthy volunteers are scanned in-vivo at three different positions by experienced sonographers. The scanning regions are: 1) the common carotid artery at 88° beam to flow angle, 2) the common carotid artery and the jugular vein at ∼ 90° beam to flow angle and 3) the bifurcation of the carotid artery. The resulting velocity estimates are displayed as vector velocity images, where the velocity vector is superimposed on a B-mode image showing the tissue structures. The volume flow is found for case 1) and when compared with MRI from the literature, a bias of approximately ∼ 20% is found. The maximum flow velocity within the carotid artery is found to be 0.8 m/s, which is normal for a healthy person. In case 3), the estimated vector velocities are compared with numerical simulations. Qualitatively similar flow pattern can be seen in both simulations and in the vector velocity images. Furthermore, a vortex is identified in the carotid sinus at the deceleration phase after the peak systole. This vortex is seen in all of the three acquired cardiac cycles. (E-mail: ju@oersted.dtu.dk)


value:
  http://pdn.sciencedirect.com/science?_ob=MiamiImageURL&_cid=271204&_user=606145&_pii=S0301562906018679&_check=y&_origin=article&_zone=toolbar&_coverDate=30-Apr-2007&view=c&originContentFamily=serial&wchp=dGLbVlk-zSkWb&md5=1274db4d6eff11f8341aefe874a494f5&pid=1-s2.0-S0301562906018679-main.pdf


value:
  Comparison of blood velocity measurements between ultrasound Doppler and accelerated phase-contrast MR angiography in small arteries with disturbed flow


value:
  Comparison of Blood Velocity Measurements between Ultrasound Doppler and Accelerated Phase-Contrast MR Angiography in Small Arteries with Disturbed Flow


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  Endoleaks following endovascular aneurysm repair (EVAR) are common and present a diagnostic challenge in the follow-up after EVAR. Contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) is a promising new method for the diagnosis and follow-up of endoleaks. CEUS with SonoVue ® allows a more rapid and noninvasive diagnosis, especially in critical patients owing to its bedside availability. This review describes the etiology, classification and importance of different types of endoleaks and compares CEUS findings with computed tomography angiography (CTA), allowing the reader to appreciate the usefulness of CEUS in this clinical situation.


value:
  Ultrasound contrast agents contain tiny gas-filled microbubbles which on intravenous injection are transported like red blood cells by the bloodstream. They are distributed to the entire macro- and microvascular system without extravasation (blood-pool tracer). Contrast-specific ultrasound modalities allow selective imaging of these microbubble contrast agents in real time, with excellent separation from underlying tissue signals. The dynamic wash-in and wash-out of a contrast bolus allows the detection and quantitative assessment of vascular flow and parenchymal perfusion. On complete filling of vascular structures the microbubble distribution delineates the vascular lumen and depicts the vascular architecture, down to tiny branches within parenchymal tissue. Mathematical models for bolus kinetics and flash/replenishment kinetics allow precise quantification of relative blood volume and blood flow, with high temporal and spatial resolution. Contrast-enhanced ultrasound examinations can be repeated at short intervals and performed at the bedside, making this diagnostic method convenient for guidance of interventions and therapy monitoring. Future applications include the use of microbubbles as target-specific molecular imaging agents and as delivery systems for local drug and gene therapies.


value:
  Abdominal aortic aneurysm repair by endovascular techniques have gained wide acceptance as a treatment option. A potential well-known complication of endovascular repair includes endoleak. Specifically, type II endoleak, which is described as retrograde flow into the aneurysm sac through collateral vessels, can occur in up to 30% of patients. Certain preoperative factors can predict which patients may develop type II endoleak. This article describes laparoscopic inferior mesenteric artery ligation prior to endovascular abdominal aortic aneurysm repair as a viable treatment option in the prevention of type II endoleak.


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  Risk factors for the development of persistent type II endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms


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  PURPOSE

  To determine, based on preoperative imaging findings, which patients treated with endovascular abdominal aneurysm repair are at high risk for the development of persistent type II endoleaks.


  MATERIALS AND METHODS

  Preoperative computed tomography (CT) angiographies of 136 patients, treated endovascularly, were retrospectively examined for possible anatomic predictors of type II endoleak development. Specifically, the number of patent aortic branches and thrombus load parameters (i.e., thickness, perimeter, area, and localization) were recorded. Thrombus load parameters were evaluated at the level of maximum aneurysm diameter, at the level of sac lumbar arteries' ostia, and at the level of inferior mesenteric artery ostium. Follow-up CT angiographies were also studied for the presence of persistent type II endoleaks (present at six-month follow-up examination). The association of these anatomic features with the development of persistent type II endoleaks was assessed using logistic regression analysis.


  RESULTS

  Aortic branch patency increased the risk for persistent type II endoleak development, while thrombus load parameters decreased this risk. In multiple logistic regression analysis, the total number of patent aortic branches (odds ratio = 4.23, 95% confidence interval = 1.72-10.42, P = 0.002 for each additional branch), and the percentage of aortic perimeter covered by a thrombus at the level of the sac lumbar arteries' ostia (odds ratio = 0.16, 95% confidence interval = 0.06-0.44, P < 0.001 for a 15% increase) were independent predictors.


  CONCLUSION

  Anatomic characteristics of a preoperative aorta can be used to predict patients with higher risk for persistent type II endoleak development.


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  Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model


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  INTRODUCTION

  Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) has been associated with lower operative mortality and morbidity than open surgery but comparable long-term mortality and higher delayed complication and reintervention rates. Attention has therefore been directed to identifying preoperative and operative variables that influence outcomes after EVAR. Risk-prediction models, such as the EVAR Risk Assessment (ERA) model, have also been developed to help surgeons plan EVAR procedures. The aims of this study were (1) to describe outcomes of elective EVAR at the Royal Brisbane and Women's Hospital (RBWH), (2) to identify preoperative and operative variables predictive of outcomes after EVAR, and (3) to externally validate the ERA model.


  METHODS

  All elective EVAR procedures at the RBWH before July 1, 2009, were reviewed. Descriptive analyses were performed to determine the outcomes. Univariate and multivariate analyses were performed to identify preoperative and operative variables predictive of outcomes after EVAR. Binomial logistic regression analyses were used to externally validate the ERA model.


  RESULTS

  Before July 1, 2009, 197 patients (172 men), who were a mean age of 72.8 years, underwent elective EVAR at the RBWH. Operative mortality was 1.0%. Survival was 81.1% at 3 years and 63.2% at 5 years. Multivariate analysis showed predictors of survival were age (P = .0126), American Society of Anesthesiologists (ASA) score (P = .0180), and chronic obstructive pulmonary disease (P = .0348) at 3 years and age (P = .0103), ASA score (P = .0006), renal failure (P = .0048), and serum creatinine (P = .0022) at 5 years. Aortic branch vessel score was predictive of initial (30-day) type II endoleak (P = .0015). AAA tortuosity was predictive of midterm type I endoleak (P = .0251). Female sex was associated with lower rates of initial clinical success (P = .0406). The ERA model fitted RBWH data well for early death (C statistic = .906), 3-year survival (C statistic = .735), 5-year survival (C statistic = .800), and initial type I endoleak (C statistic = .850).


  CONCLUSIONS

  The outcomes of elective EVAR at the RBWH are broadly consistent with those of a nationwide Australian audit and recent randomized trials. Age and ASA score are independent predictors of midterm survival after elective EVAR. The ERA model predicts mortality-related outcomes and initial type I endoleak well for RBWH elective EVAR patients.


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  The relationship of preoperative thrombus load and location to the development of type II endoleak and sac regression


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  BACKGROUND

  Few studies have specifically correlated the amount of thrombus in the aneurysm sac and the presence of type II endoleaks (TIIE). This study examined the correlation of preoperative thrombus load and location to the incidence of TIIE and late sac regression.


  METHODS

  Prospectively collected data from 266 endovascular aneurysm repair (EVAR) patients were analyzed. Maximum thrombus thickness (MTT) and percentage of the circumference of the aortic wall lined by thrombus (thrombus-lined aneurysm circumference [TLAC]) were determined from preoperative computed tomography angiography (CTA) images at four levels: neck, maximum abdominal aortic aneurysms (AAA) diameter (zone B), zone A (between neck and zone B), and zone C (between zone B and aortic bifurcation). The number of aortic side branches (ASB) was also recorded (inferior mesenteric artery [IMA], accessory renals, lumbar, and middle sacral). Logistic regression was used to determine the association of TIIE with each variable.


  RESULTS

  Thirty-three (12%) early and 32 (13%) late TIIE were noted at a mean follow-up of 22 months (range, 1-87 months). The mean MTT at zone B was 19.7 mm in patients without early TIIE and 18.8 mm in patients without late TIIE vs 14.4 and 17.2 mm in patients with early and late TIIE (P = .0137 and P = .444, respectively). The mean percentage of TLAC was 76% and 75% vs 65% and 64% in patients without vs with early and late TIIE (P = .0329 and P = .044, respectively). There was no correlation of early and late TIIE and thrombus location by zones. The IMA was patent in 7% and 7% of patients without early and late TIIE vs 16% and 15% with TIIE (P = .0367 and P = .077, respectively). The mean number of ASB in patients without (early and late) TIIE was 5.8 and 5.6 vs 5.8 and 7 with endoleak (P = .932 and P = .001, respectively). Univariate analysis showed the following variables decreased the incidence of early TIIE: MTT for zone B (odds ratio [OR] 0.79 for 5-mm increase; P = .014), MTT zone A (OR, 0.78; P = .028), MTT zone C (OR, 0.82; P = .043), and percentage of TLAC (OR, 0.88 for 10% increase; P = .036). For late TIIE: percentage of TLAC (OR, 0.88 for 10% increase; P = .048), and ASB (OR, 1.39 for each additional vessel; P = .001). A multiple regression model showed only ASB (OR, 1.34; P = .009) was a predictor for late TIIE. Four of five patients (80%) with late sac expansion vs 24 of 208 (12%) without expansion had late TIIE (P = .001).


  CONCLUSIONS

  MTT, percentage of TLAC, number of ASB, and patent IMA influenced early TIIE; however, only the number of ASB influenced late TIIE.


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  Journal of Endovascular Therapy: An Official Journal of the International Society of Endovascular Specialists


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  PURPOSE

  To examine the outcomes following interventions for type II endoleaks in patients with aneurysm sac expansion after endovascular aneurysm repair (EVAR).


  METHODS

  A retrospective review was conducted of all patients who underwent treatment for type II endoleak from July 2001 to September 2010 in a single center. In this time period, 29 (4.7%) patients (22 men; mean age 78.6 years, range 54-87) were identified as having a type II endoleak and enlargement of the aneurysm sac, meeting the criterion for treatment. All patients had at least one attempted percutaneous intervention. Patients were followed both clinically and radiographically, with computed tomographic angiography every 3 to 12 months, over a follow-up period that ranged from 1 to 10 years (mean 3.5).


  RESULTS

  Forty-eight interventions were performed on the 29 patients. Of these, 15 (56%) patients underwent multiple (2-4) procedures. Of the 11 endoleaks with an isolated inferior mesenteric artery identified as the source, initial success for transarterial embolization at 2 years was 72%, with 2 of the failures having successful secondary interventions. For the 18 endoleaks with a lumbar source, the success of the initial intervention was 17% at 2 years; repeated embolization attempts produced a 40% secondary success rate. Seven (24%) patients had continued endoleak despite multiple treatment attempts; 3 ultimately required elective aortic graft explantation. There were no ruptures or deaths during the study period. In a comparison of type II endoleak patients who had stable aneurysm sacs and those who had persistent sac expansion, the only significant differences in preoperative anatomical characteristics were a lower prevalence of mural thrombus (p = 0.036) and longer right iliac arteries (p = 0.012) in the group with sac expansion. Independent predictors of type II endoleak were mural thrombus (p<0.001), patent lumbar arteries (p = 0.004), aneurysm length (p = 0.011), and iliac artery length (p = 0.004).


  CONCLUSION

  This study demonstrates that most patients require multiple reinterventions to treat type II endoleaks; specifically, lumbar artery embolization carries a low midterm success rate.


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  Preoperative Inferior Mesenteric Artery Embolization before Endovascular Aneurysm Repair: Decreased Incidence of Type II Endoleak and Aneurysm Sac Enlargement with 24-month Follow-up


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  PURPOSE

  To review the effect of preoperative embolization of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) on subsequent endoleaks and aneurysm growth.


  MATERIALS AND METHODS

  Between August 2002 and May 2010, 108 patients underwent IMA embolization before EVAR. Coil embolization was performed in all patients in whom the IMA was successfully visualized and accessed during preoperative conventional angiography. In this cohort, the incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and repeat intervention were compared with a group of 158 consecutive patients with a patent IMA on preoperative computed tomography angiography but not on conventional angiography, who therefore did not undergo preoperative embolization.


  RESULTS

  The incidence of type II endoleak was significantly higher in patients not treated with embolization (49.4% [78 of 158] vs 34.3% [37 of 108]; P = .015). The incidence of secondary intervention for type II endoleak embolization was also significantly higher in those who did not undergo embolization (7.6% [12 of 158] vs 0.9% [one of 108]; P = .013). At 24 months, an increase in aneurysm sac volume was observed in 47% of patients in the nonembolized cohort (21 of 45), compared with 26% of patients in the embolized cohort (13 of 51; P = .03). No aneurysm ruptures or aneurysm-related deaths were observed in either group. One patient in the embolization group developed mesenteric ischemia and ultimately died.


  CONCLUSIONS

  Preoperative embolization of the IMA was associated with reduced incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and secondary intervention.


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  Outcomes of endovascular aneurysm repair with selective internal iliac artery coverage without coil embolization


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  OBJECTIVE

  Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) that also involve the common iliac artery (CIA) typically is accomplished by endograft limb extension into the external iliac artery (EIA). In order to prevent endoleak, the internal iliac artery (IIA) is usually embolized, or alternatively a branched limb is deployed. However, IIA embolization is associated with longer operative time and increased use of contrast and radiation. It has been our practice not to routinely coil embolize the IIA. The purpose of this study was to present the midterm outcomes of this approach.


  METHODS

  Between April 1997 and June 2010, 137 patients (130 men; mean age, 70.9 years; range, 45-92 years) underwent EVAR of their AAA and had IIA coverage without coil embolization in 112 patients (no embolization [NE] group) and after coil embolization in 25 patients (coil embolization [CE] group). Anatomic indications for coverage of the IIA without coil embolization included presence of adequate sealing in the distal 5 mm of the CIA, or sealing ring at the origin of the CIA, or IIA diameter <5 mm. Preoperative mean AAA size was 60 ± 14 mm, and mean CIA diameter was 38 ± 13 mm. Postoperative computed tomography (CT) scanning was performed at 1, 6, and 12 months, and yearly thereafter.


  RESULTS

  Thirty-day mortality was 0.7% (1 of 137 patients). A patient presented with gluteal skin necrosis (0.7%). The incidence of postoperative buttock claudication was not different between the two groups (NE: 15 of 112 patients; CE: 3 of 25 patients; P = .852). Procedure and fluoroscopy time, contrast use, and hospital stay were significantly reduced in the NE group. Patients were followed up for 33 ± 30 months. During follow-up, 44 patients died (32.1%) and in 3 of them (2.2%), death was AAA-related. There was no difference in cumulative survival between the two groups at 1, 2, 3, and 4 years, respectively. Secondary interventions were performed in 20 of 137 patients (14.5%), including three conversions for proximal endoleak. There was no difference between the two groups in the incidence of secondary interventions (NE: 18 of 112 patients; CE: two of 25 patients; P = .301) and freedom from reintervention at 1, 2, 3, and 4 years, respectively. Ten patients (8.9%) from the NE group presented a type II endoleak during follow-up. Seven of them were associated with the covered IIA; none required reintervention.


  CONCLUSIONS

  Stent graft coverage of the IIA without coil embolization is a safe, simple, and effective maneuver for the treatment of aortoiliac aneurysms, with a low incidence of postoperative complications and reinterventions and acceptable immediate and midterm results.


value:
  One-year multicenter results of 100 abdominal aortic aneurysm patients treated with the Endurant stent graft


value:
  OBJECTIVE

  The Endurant (Medtronic, Minneapolis, Minn) is a new stent graft specifically designed to make more patients anatomically eligible for endovascular aneurysm (EVAR). This study presents the 1-year results of 100 consecutive patients with abdominal aortic aneurysms (AAAs) treated with the Endurant stent graft in real-life practice.


  METHODS

  All clinical preoperative, operative, postoperative, and 1-year follow-up data of patients with the Endurant stent graft from three tertiary centers were prospectively collected. Patients underwent computed tomographic angiography (CTA) preoperatively, at 1 month, and at 1-year post-EVAR. The first 100 patients with an implantation date at least 1 year before our date of analysis and complete information were included. Clinical data, AAA characteristics, presence of endoleaks, graft migration, and other EVAR-related complications were noted. All values are stated as mean ± SD (range).


  RESULTS

  This study included 100 patients with AAAs (88 men) with a mean age of 73 ± 8 years (47 to 87 years), an AAA size of 61 ± 10 mm (31 to 93 mm), an AAA volume of 210 ± 122 mL (69 to 934 mL), a proximal neck length of 33 ± 14 mm (9 to 82 mm), and an infrarenal angulation of 44 ± 25° (0°-108°). Nineteen of the 100 included patients had at least one anatomic characteristic that was considered a violation of the instructions for use (IFU) of the Endurant stent graft. A primary technical success was achieved in 98% of the patients (one additional stent placement in renal artery was required; one unplanned aorto-uni-iliac device placed), with no primary type I or III endoleaks or conversions. A secondary technical success was achieved in all cases. The 30-day mortality was 2% and the first postoperative CTA documented 16 endoleaks (16%; 16 type II). One-year follow-up showed three iliac limb occlusions (3%), one infected stent graft (causing a type Ia endoleak), and five endovascular reinterventions (5%; three to treat iliac limb occlusions, one proximal extension cuff; and one stent in the renal artery). The 1-year all-cause mortality rate was 12% (12 patients) and the AAA-related mortality was 3%. The mean AAA size was significantly smaller after 1 year (diameter, 54 ± 11.8 [32-80] mm; P < .01; volume, 173 ± 119 [42-1028] mL; P < .01), and one graft migration >5 mm and 13 endoleaks were noted (12 type II, 1 type I [neck dilatation]).


  CONCLUSION

  The treatment of patients with AAAs with the Endurant stent graft seems to be successful and durable during the first year after EVAR. Despite the wider inclusion criteria for the Endurant, and with 19% of our patients treated outside the IFU, the AAA-related mortality, number of type I or III endoleaks, and reintervention rates are comparable to the results of other stent grafts.


value:
  Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair


value:
  BACKGROUND

  Previous analyses suggested that duplex ultrasonography (DUS) detected endoleaks after endovascular aneurysm repair (EVAR) with insufficient sensitivity; they did not specifically examine types 1 and 3 endoleak, which, if untreated, may lead to aneurysm-related death. In light of changes to clinical practice, the diagnostic accuracy of DUS and contrast-enhanced ultrasonography (CEUS) for types 1 and 3 endoleak required focused reappraisal.


  METHODS

  Studies comparing DUS or CEUS with computed tomography (CT) for endoleak detection were identified. CT was taken as the standard in bivariable meta-analysis.


  RESULTS

  Twenty-five studies (3975 paired scans) compared DUS with CT for all endoleaks. The pooled sensitivity was 0·74 (95 per cent confidence interval 0·62 to 0·83) and the pooled specificity was 0·94 (0·90 to 0·97). Thirteen studies (2650 paired scans) reported detection of types 1 and 3 endoleak by DUS; the pooled sensitivity of DUS was 0·83 (0·40 to 0·97) and the pooled specificity was 1·00 (0·97 to 1·00). Eleven studies (961 paired scans) compared CEUS with CT for all endoleaks. The pooled sensitivity of CEUS was 0·96 (0·85 to 0·99) and the pooled specificity was 0·85 (0·76 to 0·92). Eight studies (887 paired scans) reported detection of types 1 and 3 endoleak by CEUS. The pooled sensitivity of CEUS was 0·99 (0·25 to 1·00) and the pooled specificity was 1·00 (0·98 to 1·00).


  CONCLUSION

  Both CEUS and DUS were specific for detection of types 1 and 3 endoleak. Estimates of their sensitivity were uncertain but there was no evidence of a clinically important difference. DUS detects types 1 and 3 endoleak with sufficient accuracy for surveillance after EVAR.


value:
  Current evidence is insufficient to define an optimal threshold for intervention in isolated type II endoleak after endovascular aneurysm repair


value:
  PURPOSE

  To report a systematic review and meta-regression of the association between the threshold for intervention in patients with isolated type II endoleak after endovascular aneurysm repair (EVAR) and the fate of the aneurysm sac.


  METHODS

  Medline, trial registries, conference proceedings, and article reference lists were searched to identify case series reporting sac outcomes following a specific treatment threshold for isolated type II endoleak. Articles were classified by the threshold for intervention as conservative, selective (intervention for >5-mm sac expansion or persistent type II endoleak >6 months), or aggressive (any type II endoleak or persistent for >3 months) and sac outcomes were extracted for review. Standard meta-regression to estimate the pooled odds ratios (OR), presented with the 95% confidence interval (CI), was performed to identify whether an aggressive, selective, or conservative threshold for intervention was associated with sac expansion or sac regression.


  RESULTS

  Ten series were analyzed that reported the outcomes of isolated type II endoleak in 231 patients; of these, 56 patients were treated at an aggressive threshold, 104 at a selective threshold, and 71 at a conservative threshold. The majority (194/231, 84.0%) demonstrated either stable or shrinking sacs during follow-up. No ruptures occurred. Meta-regression demonstrated no evidence that any strategy, compared to using a conservative approach, reduced sac expansion (aggressive estimated OR 0.70, 95% CI 0.15 to 3.31, p = 0.60; selective estimated OR 1.72, 95% CI 0.49 to 6.00, p = 0.34) or improved sac regression (aggressive estimated OR 0.55, 95% CI 0.02 to 16.94, p = 0.69; selective estimated OR 5.54, 95% CI 0.39 to 79.21, p = 0.17).


  CONCLUSION

  There is inadequate information to support any one threshold for intervention. The rarity of rupture and sac expansion confirms the predominantly benign nature of isolated type II endoleak. In the absence of statistical support for a uniform approach to this problem, patient and physician preference remain key. Prospective data are still needed to investigate whether an optimum management algorithm can be devised.


value:
  PURPOSE

  To define predictive factors for endoleak type II (EL-II) based on quantifiable factors in the imaging studies of patients undergoing endovascular aneurysm repair (EVAR).


  METHODS

  The data on 208 consecutive patients (137 men; mean age 75.2 years, range 62-84) who underwent EVAR between the years 2003 and 2008 were retrospectively reviewed. The abdominal aortic aneurysm (AAA) diameter ranged from 4.8 to 12.8 cm. Data were collected on the type of AAA; the type of stent-graft (aortomonoiliac versus bifurcated); the performance of hypogastric artery embolization; the presence, number, diameter, and patency of aortoiliac branches identified on the pre and post-EVAR imaging studies; and the presence and type of EL-II (transient vs. persistent) with the goal of identifying any imaging-based predictive factors for the development of EL-II.


  RESULTS

  Among the 208 cases, 11 patients had endoleaks other than type II and were excluded, leaving 195 patients for analysis. In all, 28 (13.4%) patients were diagnosed with EL-II. All had ≥4 patent lumbar arteries (mean diameter >2.3 mm). Ten patients with a transient EL-II had a mean of 4.3 patent lumbar arteries, which had diameters <2 mm (mean 1.5 mm). In the 18 patients with persistent EL-II, the mean diameter of the 4 lumbar arteries was 2.7 mm; at least 1 of the lumbar arteries was >2 mm. The presence of at least 4 patent lumbar arteries (p<0.001) and at least 1 patent hypogastric artery (p<0.001) were predictive factors for EL-II. At least 1 lumbar artery >2 mm in diameter was a positive predictive factor for the development of persistent EL-II (p<0.001).


  CONCLUSION

  Patent hypogastric and lumbar arteries are significantly associated with a higher risk of developing EL-II. Larger diameter lumbar arteries tend to be associated with persistent EL-IIs, while lumbar arteries <2 mm would more likely be seen with a transient EL-II. If substantiated in larger studies, these angiographic criteria may guide early treatment of EL-II to avoid aneurysm sac expansion and potential rupture.


value:
  To define predictive factors for endoleak type II (EL-II) based on quantifiable factors in the imaging studies of patients undergoing endovascular aneurysm repair (EVAR). The data on 208 consecutive patients (137 men; mean age 75.2 years, range 62-84) who underwent EVAR between the years 2003 and 2008 were retrospectively reviewed. The abdominal aortic aneurysm (AAA) diameter ranged from 4.8 to 12.8 cm. Data were collected on the type of AAA; the type of stent-graft (aortomonoiliac versus bifurcated); the performance of hypogastric artery embolization; the presence, number, diameter, and patency of aortoiliac branches identified on the pre and post-EVAR imaging studies; and the presence and type of EL-II (transient vs. persistent) with the goal of identifying any imaging-based predictive factors for the development of EL-II. Among the 208 cases, 11 patients had endoleaks other than type II and were excluded, leaving 195 patients for analysis. In all, 28 (13.4%) patients were diagnosed with EL-II. All had ≥4 patent lumbar arteries (mean diameter >2.3 mm). Ten patients with a transient EL-II had a mean of 4.3 patent lumbar arteries, which had diameters <2 mm (mean 1.5 mm). In the 18 patients with persistent EL-II, the mean diameter of the 4 lumbar arteries was 2.7 mm; at least 1 of the lumbar arteries was >2 mm. The presence of at least 4 patent lumbar arteries (p<0.001) and at least 1 patent hypogastric artery (p<0.001) were predictive factors for EL-II. At least 1 lumbar artery >2 mm in diameter was a positive predictive factor for the development of persistent EL-II (p<0.001). Patent hypogastric and lumbar arteries are significantly associated with a higher risk of developing EL-II. Larger diameter lumbar arteries tend to be associated with persistent EL-IIs, while lumbar arteries <2 mm would more likely be seen with a transient EL-II. If substantiated in larger studies, these angiographic criteria may guide early treatment of EL-II to avoid aneurysm sac expansion and potential rupture.


value:
  http://media.proquest.com/media/pq/classic/doc/2390938801/fmt/pi/rep/NONE?hl=&cit%3Aauth=Marchiori%2C+Andre%3Bvon+Ristow%2C+Arno%3BGuimaraes%2C+Marcelo%3BSch%C3%B6nholz%2C+Claudio%3BUflacker%2C+Renan&cit%3Atitle=Predictive+Factors+for+the+Development+of+Type+II+Endoleaks&cit%3Apub=Journal+of+Endovascular+Therapy&cit%3Avol=18&cit%3Aiss=3&cit%3Apg=299&cit%3Adate=Jun+2011&ic=true&cit%3Aprod=ProQuest+Central&_a=20130111135425593%253A512168-107879-ONE_SEARCH-137.204.99.250-44248-874656685-DocumentImage-null-null-Online-FT-PFT-2011%252F06%252F01-2011%252F06%252F30---Online--------Scholarly%2BJournals---------PrePaid--T1M6RU1TLVBkZkRvY1ZpZXdCYXNlLWdldE1lZGlhVXJsRm9ySXRlbQ%3D%3D-%257BP-1007067-101141-CUSTOMER-10000039%252F10000155-1072210%257D&_s=gz2Dde7mQtUDfdtSdTYPa3C0wGM%3D#statusbar=1&zoom=110


value:
  BACKGROUND

  The majority of infrarenal abdominal aortic aneurysm (AAA) repairs in the United States are performed with endovascular methods. Baseline aortoiliac arterial anatomic characteristics are fundamental criteria for appropriate patient selection for endovascular aortic repair (EVAR) and key determinants of long-term success. We evaluated compliance with anatomic guidelines for EVAR and the relationship between baseline aortoiliac arterial anatomy and post-EVAR AAA sac enlargement.


  METHODS AND RESULTS

  Patients with pre-EVAR and at least 1 post-EVAR computed tomography scan were identified from the M2S, Inc. imaging database (1999 to 2008). Preoperative baseline aortoiliac anatomic characteristics were reviewed for each patient. Data relating to the specific AAA endovascular device implanted were not available. Therefore, morphological measurements were compared with the most liberal and the most conservative published anatomic guidelines as stated in each manufacturer's instructions for use. The primary study outcome was post-EVAR AAA sac enlargement (>5-mm diameter increase). In 10 228 patients undergoing EVAR, 59% had a maximum AAA diameter below the 55-mm threshold at which intervention is recommended over surveillance. Only 42% of patients had anatomy that met the most conservative definition of device instructions for use; 69% met the most liberal definition of device instructions for use. The 5-year post-EVAR rate of AAA sac enlargement was 41%. Independent predictors of AAA sac enlargement included endoleak, age ≥ 80 years, aortic neck diameter ≥ 28 mm, aortic neck angle >60°, and common iliac artery diameter >20 mm.


  CONCLUSION

  In this multicenter observational study, compliance with EVAR device guidelines was low and post-EVAR aneurysm sac enlargement was high, raising concern for long-term risk of aneurysm rupture.


value:
  OBJECTIVE

  To develop a type II endoleak porcine model with continuous pressure monitor by the strain-gauge pressure transducer and the patch.


  METHODS

  Nine tamed porcine was randomized as the experiment group of 6 domesticated pigs and the control group of 3 domesticated pigs. When the abdominal aortic aneurysm (AAA) was created, the 2(nd) and 3(rd) pair of infrarenal lumber arteries were preserved in the experiment group, while ligated in the control group. The stent-graft was implanted in the endovascular repair. CT angiography was performed to seek endoleak, and the angiography was performed to excluded the type I and type III endoleak. The pressure in the excluded AAA monitored by the strain-gauge pressure transducer was recorded and compared in both groups to evaluated the effect of type II endoleak in the experiment group.


  RESULTS

  The AAA porcine model with pressure monitor were successfully developed in all 9 porcine. The endoleak and the retrograde flow of the lumber arteries were confirmed by CT angiography in the experiment group. The ratio of the average pressure after the procedure to before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020). The ratio of the pulse pressure after the procedure to the average pressure before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020).


  CONCLUSION

  It is feasible to develop type II endoleak domesticated pig model by preserving the lumber arteries for the retrograde flow, and the AAA model with pressure monitor by the strain-gauge pressure transducer and the patch.


value:
  OBJECTIVE

  Aneurysm growth after endovascular aneurysm repair (EVAR) in patients with type II endoleak is associated with adverse outcomes. This study evaluated the long-term success of embolization of type II endoleaks in preventing aneurysm sac growth.


  METHODS

  We retrospectively reviewed outcomes of patients who underwent infrarenal EVAR who were treated for a type II endoleak between 2000 and 2008. Computed tomography scans were evaluated for aneurysm sac growth or shrinkage from the time of treatment of the endoleak. The embolization material used, graft type, target vessel embolized, and comorbidities were evaluated for their association with sac growth or shrinkage.


  RESULTS

  Ninety-five patients underwent 140 embolization procedures. The mean time from EVAR to embolization was 26.1 ± 22.2 months, and the average increase in size of the aneurysm sac from EVAR to treatment was 0.7 × 0.5 cm. Patients underwent an average of 1.6 ± 0.8 embolization procedures after EVAR. Thirteen patients underwent initial simultaneous embolization of two targets. Embolization was with glue (61%), coils (29%), glue and coils (7%), and Gelfoam (3%; Pfizer Inc, New York, NY). No abdominal aortic aneurysms (AAA) ruptured. Eight patients (8.4%) underwent graft explant and open repair; 19 (20%) required two or more embolization procedures. There was no difference in the target vessel treated or the treatment used in halting sac expansion (>5 mm). Coil embolization alone resulted in more second procedures. The 5-year cumulative survival was 65% (95% confidence interval [CI], 52%-77%), freedom from explant was 89% (95% CI, 81%-97%), freedom from second embolization was 76% (95% CI, 66%-86%), and freedom from sac expansion >5 mm was 44% (95% CI 30%-50%). Univariable analysis identified continued tobacco use (hazard ratio [HR], 2.30; 95% CI, 1.02-5.13; P = .04) was associated with continued sac expansion, and hyperlipidemia (HR, 9.64; 95% CI, 2.22-41.86) was associated with patients requiring a second embolization procedure.


  CONCLUSIONS

  Embolization of type II endoleaks is successful early in preventing aneurysm sac growth and rupture after EVAR. However, a significant number of patients require more than one procedure, and at 5 years, many patients who underwent embolization of a type II endoleak continued to experience sac growth. Patients with hyperlipidemia who undergo coil embolization are more likely to require a second embolization procedure, and patients who smoke have a higher likelihood of AAA sac expansion after embolization. Continued long-term surveillance is necessary in this cohort of patients.


value:
  There is considerable interest in computational and experimental flow investigations within abdominal aortic aneurysms (AAAs). This task stipulates advanced grid generation techniques and cross-validation because of the anatomical complexity. The purpose of this study is to examine the feasibility of velocity measurements by particle tracking velocimetry (PTV) in realistic AAA models. Computed tomography and rapid prototyping were combined to digitize and construct a silicone replica of a patient-specific AAA. Three-dimensional velocity measurements were acquired using PTV under steady averaged resting boundary conditions. Computational fluid dynamics (CFD) simulations were subsequently carried out with identical boundary conditions. The computational grid was created by splitting the luminal volume into manifold and nonmanifold subsections. They were filled with tetrahedral and hexahedral elements, respectively. Grid independency was tested on three successively refined meshes. Velocity differences of about 1% in all three directions existed mainly within the AAA sack. Pressure revealed similar variations, with the sparser mesh predicting larger values. PTV velocity measurements were taken along the abdominal aorta and showed good agreement with the numerical data. The results within the aneurysm neck and sack showed average velocity variations of about 5% of the mean inlet velocity. The corresponding average differences increased for all velocity components downstream the iliac bifurcation to as much as 15%. The two domains differed slightly due to flow-induced forces acting on the silicone model. Velocity quantification through narrow branches was problematic due to decreased signal to noise ratio at the larger local velocities. Computational wall pressure and shear fields are also presented. The agreement between CFD simulations and the PTV experimental data was confirmed by three-dimensional velocity comparisons at several locations within the investigated AAA anatomy indicating the feasibility of this approach.


value:
  Dynamic CT angiography after abdominal aortic endovascular aneurysm repair: differences in contrast agent dynamics in the aorta and endoleaks--preliminary results


value:
  PURPOSE

  To assess differences in aortic and endoleak enhancement in patients after endovascular aneurysm repair (EVAR) with dynamic computed tomography (CT) angiography.


  MATERIALS AND METHODS

  Twenty-one consecutive patients (mean age, 74.5 y ± 6; range, 61-88 y) with endoleaks after EVAR of the abdominal aorta were examined on a second-generation dual-source CT unit with 10 unidirectional scan phases (temporal resolution, 5 s; 80 kV; 120 reference-mAs; z-axis field of view, 283 mm), followed by a venous scan phase. Enhancement was assessed in aorta and endoleaks for all phases by density measurements. The diagnostic reliability of endoleak detection was assessed on a five-point confidence scale.


  RESULTS

  In total, 26 endoleaks (type I, n = 1; type II, n = 25) were detected. The highest detection rate was found in phase 5 (22 s after threshold; P < .01 vs other dynamic phases). Mean peak aortic enhancement (560 HU ± 96) was present in an early arterial phase (phase 3, 12 s after threshold), whereas the mean peak endoleak enhancement (398 HU ± 174) for type II endoleaks was present later, in phase 4 (17 s after threshold). Despite perceived high diagnostic confidence in phases 1 and 2 (ie, typical arterial phase of biphasic CT protocol), only 23% and 62% of endoleaks were detected, respectively, whereas peak diagnostic confidence (phases 4 and 5) corresponded well with the maximum endoleak detection rate but decreased significantly in later phases (ie, 6-10).


  CONCLUSIONS

  Preliminary dynamic CT angiography results in post-EVAR follow-up revealed notably different peaks of endoleak and aortic enhancement, which are not covered sufficiently by conventional biphasic CT protocols. Phase 5 demonstrated the highest type II endoleak detection rate, with high diagnostic confidence.


value:
  Color and Power Doppler US for Diagnosing Carpal Tunnel Syndrome and Determining Its Severity: A Quantitative Image Processing Method — Appendix E1


value:
  Delta-projection imaging on contrast-enhanced ultrasound to quantify tumor microvasculature and perfusion


value:
  RATIONALE AND OBJECTIVES

  The aim of this study was to assess the Delta-projection image processing technique for visualizing tumor microvessels and for quantifying the area of tissue perfused by them on contrast-enhanced ultrasound images.


  MATERIALS AND METHODS

  The Delta-projection algorithm was implemented to quantify perfusion by tracking the running maximum of the difference (Delta) between the contrast-enhanced ultrasound image sequence and a baseline image. Twenty-five mice with subcutaneous K1735 melanomas were first imaged with contrast-enhanced grayscale and then with minimum-exposure contrast-enhanced power Doppler (minexCPD) ultrasound. Delta-projection images were reconstructed from the grayscale images and then used to evaluate the evolution of tumor vascularity during the course of contrast enhancement. The extent of vascularity (ratio of the perfused area to the tumor area) for each tumor was determined quantitatively from Delta-projection images and compared to the extent of vascularity determined from contrast-enhanced power Doppler images. Delta-projection and minexCPD measurements were compared using linear regression analysis.


  RESULTS

  Delta-projection was successfully performed in all 25 cases. The technique allowed the dynamic visualization of individual blood vessels as they filled in real time. Individual tumor blood vessels were distinctly visible during early image enhancement. Later, as an increasing number of blood vessels were filled with the contrast agent, clusters of vessels appeared as regions of perfusion, and the identification of individual vessels became difficult. Comparisons were made between the perfused area of tumors in Delta-projections and in minexCPD images. The Delta-projection perfusion measurements were correlated linearly with minexCPD.


  CONCLUSION

  Delta-projection visualized tumor vessels and enabled the quantitative assessment of the tumor area perfused by the contrast agent.


value:
  26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2004. IEMBS '04


value:
  Contrast enhanced ultrasound image segmentation based on fuzzy competitive clustering and anisotropic diffusion


value:
  Doppler has been used for many years for cardiovascular exploration in order to visualize the walls and anatomical or functional diseases. The use of ultrasound contrast agents makes it possible to improve ultrasonic information. Thus, harmonic imaging is a powerful tool for characterizing pathologies by their vascularity. However, images are buried in noise. We present an approach for noise reduction and structural features enhancement based on nonlinear anisotropic diffusion, coupled with fuzzy clustering segmentation to delineate liver pathologies.


value:
  Ultrasound provides a valuable tool for medical diagnosis offering real-time imaging with excellent spatial resolution and low cost. The advent of microbubble contrast agents has provided the additional ability to obtain essential quantitative information relating to tissue vascularity, tissue perfusion and even endothelial wall function. This technique has shown great promise for diagnosis and monitoring in a wide range of clinical conditions such as cardiovascular diseases and cancer, with considerable potential benefits in terms of patient care. A key challenge of this technique, however, is the existence of significant variations in the imaging results, and the lack of understanding regarding their origin. The aim of this paper is to review the potential sources of variability in the quantification of tissue perfusion based on microbubble contrast-enhanced ultrasound images. These are divided into the following three categories: (i) factors relating to the scanner setting, which include transmission power, transmission focal depth, dynamic range, signal gain and transmission frequency, (ii) factors relating to the patient, which include body physical differences, physiological interaction of body with bubbles, propagation and attenuation through tissue, and tissue motion, and (iii) factors relating to the microbubbles, which include the type of bubbles and their stability, preparation and injection and dosage. It has been shown that the factors in all the three categories can significantly affect the imaging results and contribute to the variations observed. How these factors influence quantitative imaging is explained and possible methods for reducing such variations are discussed.


value:
  http://www.healthcare.philips.com/pwc_hc/main/shared/Assets/Documents/Ultrasound/Products/Campaigns/Pushing%20the%20Boundaries/Contrast_In_Research_White_Paper.pdf


value:
  BACKGROUND AND PURPOSE

  The canine vein pouch aneurysm model is widely used for testing and development of devices directed at the endovascular treatment of aneurysms. Our purpose was to determine the incidence of spontaneous thrombosis and rupture of these aneurysms.


  MATERIALS AND METHODS

  A retrospective review of laboratory records of canine vein pouch aneurysms made during a 6-year period was performed. The aneurysm and parent artery dimensions as well as incidences of spontaneous thrombosis and rupture were noted.


  RESULTS

  During the interval studied, 326 vein patch aneurysms were made in 310 canines. Of these, 102 were sidewall (lateral) and 224 were bifurcation aneurysms. Spontaneous occlusion occurred in 9 of the sidewall aneurysms and in only 1 of the bifurcation aneurysms. None of the aneurysms ruptured.


  CONCLUSION

  Spontaneous occlusion of the sidewall canine vein patch aneurysm occurred less than 10% of the time; in the bifurcation aneurysms, it almost never occurred. These characteristics enhance the value of this model for use in testing of devices intended for the endovascular treatment of aneurysms.


value:
  The objectives of this study were to investigate the consistency, patency, and natural history of a vein graft canine aneurysm model and to determine the effectiveness of various coil designs on inducing aneurysm thrombosis. Twenty-one sacculuslike aneurysms were created in mongrel dogs by anastomosing a vein pouch to the common carotid artery. The model produced wide-neck aneurysms with 100% patency. The canine vein graft aneurysm provided an excellent model for the evaluation of endovascular devices. Three types of specially designed platinum coils were placed in the aneurysms: those with simple curves, those with complex curves, and those with flower petal curves and silk fibers. These coils were placed by the endovascular route by means of microcatheters. Flower petal coils with silk fibers were effective in producing thrombosis of the aneurysms, suggesting that coils of the appropriate design may be useful in the endovascular treatment of aneurysms. The other coil designs evaluated, those with simple and complex curves without silk fibers, demonstrated insufficient thrombogenicity and spatial stability.


value:
  http://www.ajnr.org/content/11/2/249.abstract?ijkey=5e6a31c76f84ea129dd6959099f8fc78f04a811d&keytype2=tf_ipsecsha


value:
  BACKGROUND AND PURPOSE: The canine vein pouch aneurysm model is widely used for testing and development of devices directed at the endovascular treatment of aneurysms. Our purpose was to determine the incidence of spontaneous thrombosis and rupture of these aneurysms.
  MATERIALS AND METHODS: A retrospective review of laboratory records of canine vein pouch aneurysms made during a 6-year period was performed. The aneurysm and parent artery dimensions as well as incidences of spontaneous thrombosis and rupture were noted.
  RESULTS: During the interval studied, 326 vein patch aneurysms were made in 310 canines. Of these, 102 were sidewall (lateral) and 224 were bifurcation aneurysms. Spontaneous occlusion occurred in 9 of the sidewall aneurysms and in only 1 of the bifurcation aneurysms. None of the aneurysms ruptured.
  CONCLUSION: Spontaneous occlusion of the sidewall canine vein patch aneurysm occurred less than 10% of the time; in the bifurcation aneurysms, it almost never occurred. These characteristics enhance the value of this model for use in testing of devices intended for the endovascular treatment of aneurysms.


value:
  Reliable models of aortic aneurysms are required to test endovascular stent-graft technology prior to human use. We describe the creation of a standardized prosthetic aneurysm in an ovine model to assess endovascular technology. In an adult ovine model under general anesthesia, a polyester sphere measuring 6 cm across was sutured onto the infrarenal aorta following aortotomy. Two weeks later an endovascular stent-graft was deployed in the aorta. Exclusion was confirmed on monthly ultrasound duplex and during angiography at three months and under terminal anesthesia at six months. Autopsy along with histology of the specimen were then performed. A total of 10 sheep underwent aneurysm implantation. Nine received a straight tube endovascular stent-graft (Lombard Medical, Abingdon, Oxon, UK) and seven completed the study. Five prosthetic aneurysms shrank during serial imaging with duplex ultrasound and angiography. However, two remained the same size. One of these had a type I endoleak whereas the other had endotension (type I endoleak confirmed at autopsy). This animal model provides a reliable and reproducible method of creating prosthetic aneurysms for assessing endovascular stent-grafts. It was possible to assess aneurysm exclusion non-invasively using duplex ultrasound. Aneurysms effectively excluded from the circulation shrank whereas those with an endoleak did not.


value:
  Type II endoleaks after endovascular repair of abdominal aortic aneurysms: fate of the aneurysm sac and neck changes during long-term follow-up


value:
  PURPOSE

  To evaluate the frequency of type II endoleaks after endovascular aneurysm repair (EVAR) and to compare sac diameter and neck changes in patients with type II endoleak to endoleak-free patients with at least 3-year imaging follow-up.


  METHODS

  Among 407 consecutive EVAR patients, 109 patients (101 men; mean age 72.1 years, range 55-86) had at least 3-year computed tomography (CT) data and no type I or III endoleak. In this cohort, 49 patients presented with a type II endoleak at some time and 60 patients had no endoleak. Patients with type II endoleaks were further divided into subgroups based on the vessel origin and the perfusion status (persistent or transient). The course of the perfusion status of type II endoleaks and changes in the aneurysm sac diameters, neck diameters, and renal to stent-graft distances (RSD) were evaluated in the defined groups. Reintervention and death rates were also reported.


  RESULTS

  The mean follow-up was 68.1 ± 23.8 months. Compared to the no endoleak group, overall sac diameter increased significantly in the type II endoleak group (p = 0.007), but vessel origin did not have any influence. With regard to the perfusion status of type II endoleaks, aneurysm sac changes were significantly higher (p = 0.002) in the persistent endoleak group. During the study period, the increase in the proximal neck diameter was significantly higher in the no endoleak group compared to the type II endoleak group (p = 0.025). No significant difference was found in RSD changes between the defined groups. Reinterventions were performed in 20 (18.3%) patients (13 for type II endoleak); 2 (1.8%) patients without type II endoleak died of ruptured aneurysm.


  CONCLUSION

  Persistent type II endoleaks led to significant aneurysm sac enlargement, but without increased mortality or rupture rates.


value:
  PURPOSE

  The purpose of this study was to develop a reliable in vivo porcine model of type II endoleak resulting from endovascular aortic aneurysm repair (EVAR), for the study and treatment of type II endoleak.


  METHODS

  Eight pigs underwent creation of an infrarenal aortic aneurysm, with a Dacron patch with preservation of lumbar branches. An indwelling pressure transducer was placed in the aneurysm sac. After 1 week the animals underwent EVAR with a custom-made Talent endograft. After another week the animals underwent laparoscopic lumbar artery ligation. Abdominal and pelvic computed tomography was performed after each procedure. Aneurysm sac pressure was measured in sedated and awake animals.


  RESULTS

  All eight animals underwent successful creation of an aortic aneurysm and EVAR resulting in exclusion of the aneurysm sac. After creation of the aneurysm the sac mean arterial pressure (MAP) was 72.5 +/- 6.1 mm Hg and the sac pulse pressure was 44.8 +/- 8.7 mm Hg. Postoperative computed tomography scans demonstrated a type II endoleak from the lumbar branches in all animals. While aneurysm sac MAP (56.5 +/- 7.9 mm Hg; P <.01) and pulse pressure (13.6 +/- 4.1 mm Hg; P <.01) decreased after EVAR, sac pulse pressure remained, with type II endoleak. All animals underwent laparoscopic lumbar artery ligation, which resulted in further reduction in the sac MAP (38.3 +/- 4.6 mm Hg; P <.02) and immediate absence of sac pulse pressure (0 mm Hg; P <.01). Necropsy confirmed the absence of collateral flow in the aneurysm sac, with fresh thrombus formation in all animals.


  CONCLUSION

  We present a reliable and clinically relevant in vivo large animal model of type II endoleak.


  CLINICAL RELEVANCE

  We set out to show that aortic aneurysm sac pressurization caused by lumbar arterial flow in the setting of type II endoleak can be reproduced in an in vivo porcine model of endovascular aortic aneurysm repair. Indeed, in this model the aneurysm sac pulse pressure was a sensitive indicator of type II endoleak, correlating well with findings at computed tomography, and lumbar artery ligation eliminated the endoleak, as demonstrated on computed tomography scans and sac pressure measurement. Therefore we believe this in vivo large animal model can be instrumental in the study of many aspects of the physiologic features of type II endoleak.


value:
  OBJECTIVE

  Persistent type 2 endoleaks (PT2, present >or=6 months) after endovascular aneurysm repair (EVAR) are associated with adverse outcomes. This study evaluated the preoperative risk factors and natural history of PT2 in order to define a population at high risk.


  METHODS

  From January 1999 to December 2007, 595 of 832 EVAR patients had long-term computed tomography follow-up and comprised the study cohort. Preoperative anatomic and clinical variables were correlated with PT2 using Cox regression. Composite hazard ratios (HRs) were constructed with clusters of high-risk preoperative variables. Primary end points, including spontaneous resolution, sac enlargement >5 mm, and freedom from reintervention, were evaluated using Kaplan-Meier analysis.


  RESULTS

  There were 136 PT2 patients (23%) with a median follow-up of 34.8 months (range, 6.4-121.2 months). Positive predictive factors included patent inferior mesenteric artery (IMA; HR, 4.00; 95% confidence interval [CI], 1.62-9.90; P = .003), increasing number of patent lumbar arteries (HR, 1.24; 95% CI, 1.10-1.41; P = .0006), increasing age (HR, 1.04; 95% CI, 1.01-1.06; P = .005), and increasing luminal diameter on CT-contrast opacified lumen (HR, 1.03; 95% CI, 1.02-1.05; P = .0001). During follow-up, spontaneous PT2 resolution occurred in 34 patients (25%), sac diameter remained stable in 63 (46%), and rupture occurred in 2 (1.5%). Kaplan-Meier analysis estimated that 35.2% +/- 5.6% (95% CI, 23.8%-46.2%) of PT2 resolve spontaneously at 5 years after the index procedure. Freedom from sac enlargement >5 mm was 54.6% +/- 7.2% (95% CI, 40.6%-69.4%) at 5 years. Fifty-nine reinterventions were performed in 39 patients with PT2. Freedom from reintervention was 67.3% +/- 5.0% (95% CI, 57.0%-77.0%) at 5 years. The combination of a patent IMA and one risk factor of more than six patent lumbar arteries, maximum luminal diameter >30 mm, or age >70 years increased the odds of PT2 approximately ninefold. The combination of a patent IMA and any two risk factors increased the odds of PT2 approximately 18-fold.


  CONCLUSIONS

  Several readily identifiable preoperative variables are associated with PT2 whose natural history was benign in but 35% of patients. On the basis of the composite high-risk HRs, there is accordingly a cohort of patients in whom perioperative interventions to preclude PT2 should be considered.


value:
  PURPOSE

  To assess the significance of a patent inferior mesenteric artery (IMA) and presence of intrasac thrombus on the outcome of endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA).


  METHODS

  Between June 2004 and June 2007, 114 AAA patients (100 men; mean age 75 years, range 56-87) treated electively with a bifurcated stent-graft were assessed with computed tomography pre- and postoperatively. Incidences of type II endoleaks and reinterventions were compared with preoperative intrasac thrombus and IMA patency.


  RESULTS

  Over a mean follow-up of 19 months (range 6-38), there was no aneurysm rupture. Eleven (11%) of 101 patients with and 7 (54%) of 13 patients without preoperative intrasac thrombus presented with a type II endoleak (p<0.01). The postoperative change in aneurysm diameter was 0 mm (-20 to 16) in 18 patients with type II endoleak and -9 mm (-30 to 18) in sealed aneurysms (p<0.001). Fourteen (78%) type II endoleaks originated from lumbar arteries and 4 (22%) from the IMA in spite of the fact that most patients (69%) had a patent IMA. There were 5 reinterventions for type II endoleak with expansion of the sac. The reinterventions did not seem related to intrasac thrombus or a patent IMA. Prophylactic embolization of the IMA was unsuccessful in 4 (33%) cases.


  CONCLUSION

  In this series, type II endoleaks inhibited sac shrinkage and occurred more frequently in aneurysms without intrasac thrombus. Most type II endoleaks originated from lumbar arteries and not from the IMA. Prophylactic embolization of the IMA does not seem justified and is not always technically successful.


value:
  BACKGROUND

  Endovascular repair has been shown to be superior to open repair of abdominal aortic aneurysm in terms of aneurysm-related survival. However, endovascular repair has its own unique complications such as endoleak. Type II endoleaks may be associated with aortic rupture. We attempt to identify patient variables associated with the development of endoleaks and hence facilitate their early identification.


  METHODS

  Endovascular repair was carried out for non-ruptured, infrarenal abdominal aortic aneurysms. Patients underwent preoperative computed tomography and angiography and were followed up with computed tomography and/or ultrasound scan at 1, 3 and 6 months and yearly thereafter. Univariate and multivariate analysis was used to identify any patient factors associated with the risk for developing an endoleak.


  RESULTS

  One hundred and one patients were included in the study (12 female : 89 male). Age 59-93 years. Mean follow up was 20.2 months. Type II endoleaks developed in 26 (25.7%) patients. Fifteen cases resolved during follow up, three of which required secondary intervention. Nine cases persist. No aneurysms ruptured. The presence of patent inferior mesenteric artery (P < 0.001) and sac enlargement (P = 0.001) were associated with development of endoleak as was diabetes in a multivariate model (P = 0.005). History of smoking (P = 0.01) was a protective factor. The presence of four or more lumbar arteries (P = 0.55) was not associated with increased risk.


  CONCLUSIONS

  It is possible to identify individual patient risk factors associated with risk for developing type II endoleaks and it may be possible to modify screening practice as a result. The association between patent inferior mesenteric artery preoperatively and endoleak is further confirmed. Spontaneous sealing of endoleaks is common and rupture is rare. Early intervention is not mandatory.


# itemNotes

title: Welcome to Zotero!
note:
  <div class="zotero-note znv1"><p><strong>Welcome to Zotero!</strong></p><p>View the Quick Start Guide to learn how to begin collecting, managing, citing, and sharing your research sources.</p><p>Thanks for installing Zotero.</p></div>


title: Benvenuti su Zotero.
note:
  <div class="zotero-note znv1"><p><strong>Benvenuti su Zotero.</strong></p><p>Consulta la Guida Rapida per apprendere come raccogliere, gestire, citare e condividere le tue fonti bibliografiche.</p><p>Grazie per aver installato Zotero.</p></div>


title: ed of telemetry systems able to provide wireless bidirectional communication
note:
  <div class="zotero-note znv1"><blockquote cite="http://www.ncbi.nlm.nih.gov/pubmed/16504564">
  <p>ed of telemetry systems able to provide wireless bidirectional communication to interrogate and remotely program the device, as well as to monitor the physiological status of the patient, is growing. The object of the present study was to evaluate a new hermetic antenna for wireless short-range transmission system for IMDs which would assure reliable long-ter</p>
  </blockquote></div>


title: Nuova nota indipendente
note:
  <div class="zotero-note znv1"><p>Nuova nota indipendente</p>
  <blockquote cite="zotero://attachment/51/">
  <p>The authors found a steady decrease in hospitalisation rates with AMI, and a shift away from STEMI towards rising rates of NSTEMI patients who are increasingly older.</p>
  </blockquote>
  <blockquote cite="http://www.ncbi.nlm.nih.gov/pubmed/11179267">
  <p>&nbsp;</p>
  </blockquote></div>


title: Note relative alla pubbblicazione di Cutrì et al
note:
  <div class="zotero-note znv1"><p>Note relative alla pubbblicazione di Cutrì et al</p>
  <p>&nbsp;</p></div>


title: The following values have no corresponding Zotero field:
note:
  <div class="zotero-note znv1">The following values have no corresponding Zotero field:<br/>Author Address: Department of Cardiovascular Disease, Vascular and Endovascular Surgery, and Angiology, Cittadella Hospital, Padua, Italy<br/>Author Address: Department of Radiology, Cittadella Hospital, Padua, Italy<br/>Author Address: Division of Cardiology, Cittadella Hospital, Padua, Italy<br/>Author Address: Department of Prevention, Epidemiology Unit, Cittadella Hospital, Padua, Italy<br/></div>


title: This is fourth edition of Treatment of tuberculosis: guidelines, adhering fu
note:
  <div class="zotero-note znv1"><blockquote cite="zotero://attachment/196/">
  <p>This is fourth edition of Treatment of tuberculosis: guidelines, adhering fully to the new WHO process for evidence-based guidelines. Several important recommendations are being promoted in this new edition.</p>
  </blockquote></div>


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  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcs",
  	"lastUpdated": "2012-03-06 05:20:00"
  }


leafName: Verniana-Jules Verne Studies.js
translatorJSON:
  {
  	"translatorID": "cdf8269c-86b9-4039-9bc4-9d998c67740e",
  	"translatorType": 4,
  	"label": "Verniana-Jules Verne Studies",
  	"creator": "Aurimas Vinckevicius",
  	"target": "https?://[^/]*verniana.org(:\\d+)?/volumes/\\d+/",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsb",
  	"lastUpdated": "2012-03-06 05:20:00"
  }


leafName: AfroEuropa.js
translatorJSON:
  {
  	"translatorID": "4f62425a-c99f-4ce1-b7c1-5a3ac0d636a3",
  	"translatorType": 4,
  	"label": "AfroEuropa",
  	"creator": "Michael Berkowitz",
  	"target": "^https?://journal\\.afroeuropa\\.eu/",
  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-09-17 23:30:00"
  }


leafName: AGU Journals.js
translatorJSON:
  {
  	"translatorID": "9220fa99-b936-430e-a8ea-43ca6cb04145",
  	"translatorType": 4,
  	"label": "AGU Journals",
  	"creator": "Sebastian Karcher and Ben Parr",
  	"target": "^https?://(?:www\\.|europa\\.)?agu\\.org",
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsv",
  	"lastUpdated": "2012-09-28 06:50:00"
  }


leafName: AlterNet.js
translatorJSON:
  {
  	"translatorID": "ea531652-cdeb-4ec2-940e-627d4b107263",
  	"translatorType": 4,
  	"label": "AlterNet",
  	"creator": "Jesse Johnson, BBUCommander",
  	"target": "^https?://(?:www\\.)alternet\\.org",
  	"minVersion": "2.1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-08-25 06:35:00"
  }


leafName: Aluka.js
translatorJSON:
  {
  	"translatorID": "e8fc7ebc-b63d-4eb3-a16c-91da232f7220",
  	"translatorType": 4,
  	"label": "Aluka",
  	"creator": "Sean Takats, Sebastian Karcher",
  	"target": "^https?://(?:www\\.)aluka\\.org/action/(?:showMetadata\\?doi=[^&]+|doSearch\\?|doBrowseResults\\?)",
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-08-06 19:30:00"
  }


leafName: ASCE.js
translatorJSON:
  {
  	"translatorID": "303bdfc5-11b8-4107-bca1-63ca97701a0f",
  	"translatorType": 4,
  	"label": "ASCE",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://(www\\.)?ascelibrary\\.org/",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-06-25 03:25:00"
  }


leafName: AustLII and NZLII.js
translatorJSON:
  {
  	"translatorID": "5ed5ab01-899f-4a3b-a74c-290fb2a1c9a4",
  	"translatorType": 4,
  	"label": "AustLII and NZLII",
  	"creator": "Bill McKinney and Sebastian Karcher",
  	"target": "^https?://www\\.(?:austlii\\.edu\\.au|nzlii\\.org)",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-05-16 23:55:00"
  }


leafName: BBC.js
translatorJSON:
  {
  	"translatorID": "f4130157-93f7-4493-8f24-a7c85549013d",
  	"translatorType": 4,
  	"label": "BBC",
  	"creator": "Ben Parr",
  	"target": "^https?://(?:www|news?)\\.bbc\\.co\\.uk",
  	"minVersion": "1.0.0b4.r1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-08-06 19:30:00"
  }


leafName: BIUM.js
translatorJSON:
  {
  	"translatorID": "cae7d3ec-bc8d-465b-974f-8b0dcfe24290",
  	"translatorType": 4,
  	"label": "BIUM",
  	"creator": "Michael Berkowitz",
  	"target": "http://hip.bium.univ-paris5.fr/",
  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "g",
  	"lastUpdated": "2012-05-25 03:45:00"
  }


leafName: Canadiana.ca.js
translatorJSON:
  {
  	"translatorID": "2d174277-7651-458f-86dd-20e168d2f1f3",
  	"translatorType": 4,
  	"label": "Canadiana.ca",
  	"creator": "Adam Crymble, Sebastian Karcher",
  	"target": "^https?://eco\\.canadiana\\.ca",
  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-07-03 23:30:00"
  }


leafName: CARLABRC OAI Harvester.js
translatorJSON:
  {
  	"translatorID": "31649d9d-8f7e-4b87-8678-b3e68ee98f39",
  	"translatorType": 4,
  	"label": "CARL/ABRC OAI Harvester",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://carl-abrc-oai",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-05-11 06:30:00"
  }


leafName: Champlain Society - Collection.js
translatorJSON:
  {
  	"translatorID": "50d3ca81-3c4c-406b-afb2-0fe8105b9b38",
  	"translatorType": 4,
  	"label": "Champlain Society - Collection",
  	"creator": "Adam Crymble",
  	"target": "^https?://link\\.library\\.utoronto\\.ca",
  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-07-13 07:40:00"
  }


leafName: Civilization.ca.js
translatorJSON:
  {
  	"translatorID": "8451431a-895f-4732-8339-79eb6756d2f9",
  	"translatorType": 4,
  	"label": "Civilization.ca",
  	"creator": "Adam Crymble",
  	"target": "^https?://collections\\.civilization\\.ca",
  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-07-13 07:40:00"
  }


leafName: Code4Lib Journal.js
translatorJSON:
  {
  	"translatorID": "a326fc49-60c2-405b-8f44-607e5d18b9ad",
  	"translatorType": 4,
  	"label": "Code4Lib Journal",
  	"creator": "Michael Berkowitz",
  	"target": "http://journal.code4lib.org/",
  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-05-11 06:30:00"
  }


leafName: COinS.js
translatorJSON:
  {
  	"translatorID": "05d07af9-105a-4572-99f6-a8e231c0daef",
  	"translatorType": 6,
  	"label": "COinS",
  	"creator": "Simon Kornblith",
  	"target": null,
  	"minVersion": "2.1",
  	"maxVersion": null,
  	"priority": 250,
  	"inRepository": true,
  	"browserSupport": "gcsv",
  	"lastUpdated": "2012-05-04 05:35:00"
  }

code:
  {
  	"translatorID": "05d07af9-105a-4572-99f6-a8e231c0daef",
  	"translatorType": 6,
  	"label": "COinS",
  	"creator": "Simon Kornblith",
  	"target": null,
  	"minVersion": "2.1",
  	"maxVersion": null,
  	"priority": 250,
  	"inRepository": true,
  	"browserSupport": "gcsv",
  	"lastUpdated": "2012-05-04 05:35:00"
  }

  function detectWeb(doc, url) {
  	var spanTags = doc.getElementsByTagName("span");

  	var encounteredType = false;
  	
  	// This and the x: prefix in the XPath are to work around an issue with pages
  	// served as application/xhtml+xml
  	//
  	// https://developer.mozilla.org/en/Introduction_to_using_XPath_in_JavaScript#Implementing_a_default_namespace_for_XML_documents
  	function nsResolver() {
  		return 'http://www.w3.org/1999/xhtml';
  	}
  	
  	var spans = doc.evaluate('//x:span[contains(@class, " Z3988") or contains(@class, "Z3988 ") or @class="Z3988"][@title]', doc, nsResolver, XPathResult.ANY_TYPE, null);
  	var span;
  	while(span = spans.iterateNext()) {
  		// determine if it's a valid type
  		var item = new Zotero.Item;
  		var success = Zotero.Utilities.parseContextObject(span.title, item);
  		
  		if(item.itemType) {
  			if(encounteredType) {
  				return "multiple";
  			} else {
  				encounteredType = item.itemType;
  			}
  		}
  	}
  	
  	return encounteredType;
  }

  // used to retrieve next COinS object when asynchronously parsing COinS objects
  // on a page
  function retrieveNextCOinS(needFullItems, newItems, couldUseFullItems, doc) {
  	if(needFullItems.length) {
  		var item = needFullItems.shift();
  		
  		Zotero.debug("looking up contextObject");
  		var search = Zotero.loadTranslator("search");
  		search.setHandler("itemDone", function(obj, item) {
  			newItems.push(item);
  		});
  		search.setHandler("done", function() {
  			retrieveNextCOinS(needFullItems, newItems, couldUseFullItems, doc);
  		});
  		// Don't throw on error
  		search.setHandler("error", function() {});
  		// look for translators
  		search.setHandler("translators", function(obj, translators) {
  			if(translators.length) {
  				search.setTranslator(translators);
  				search.translate();
  			} else {
  				retrieveNextCOinS(needFullItems, newItems, couldUseFullItems, doc);
  			}
  		});
  		
  		search.setSearch(item);
  		search.getTranslators();
  	} else {
  		completeCOinS(newItems, couldUseFullItems, doc);
  		Zotero.done();
  	}
  }

  // saves all COinS objects
  function completeCOinS(newItems, couldUseFullItems, doc) {
  	if(newItems.length > 1) {
  		var selectArray = new Array(newItems.length);
  		for(var i in newItems) {
  			selectArray[i] = newItems[i].title;
  		}
  		
  		Zotero.selectItems(selectArray, function (selectArray) {
  			var useIndices = new Array();
  			for(var i in selectArray) {
  				useIndices.push(i);
  			}
  			completeItems(newItems, useIndices, couldUseFullItems, doc);
  		});
  	} else if(newItems.length) {
  		completeItems(newItems, [0], couldUseFullItems, doc);
  	}
  }

  function completeItems(newItems, useIndices, couldUseFullItems, doc) {
  	if(!useIndices.length) {
  		return;
  	}
  	var i = useIndices.shift();
  	
  	// grab full item if the COinS was missing an author
  	if(couldUseFullItems[i]) {
  		Zotero.debug("looking up contextObject");
  		var search = Zotero.loadTranslator("search");
  		
  		var firstItem = false;
  		search.setHandler("itemDone", function(obj, newItem) {
  			if(!firstItem) {
  				// add doc as attachment
  				newItem.attachments.push({document:doc});
  				newItem.complete();
  				firstItem = true;
  			}
  		});
  		search.setHandler("done", function(obj) {
  			// if we didn't find anything, use what we had before (even if it
  			// lacks the creator)
  			if(!firstItem) {
  				newItems[i].complete();
  			}
  			// call next
  			completeItems(newItems, useIndices, couldUseFullItems);
  		});
  		// Don't throw on error
  		search.setHandler("error", function() {});
  		search.setHandler("translators", function(obj, translators) {
  			if(translators.length) {
  				search.setTranslator(translators);
  				search.translate();
  			} else {
  				// add doc as attachment
  				newItems[i].attachments.push({document:doc});
  				newItems[i].complete();
  				// call next
  				completeItems(newItems, useIndices, couldUseFullItems);
  			}
  		});
  		
  		search.setSearch(newItems[i]);
  		search.getTranslators();
  	} else {
  		// add doc as attachment
  		newItems[i].attachments.push({document:doc});
  		newItems[i].complete();
  		// call next
  		completeItems(newItems, useIndices, couldUseFullItems);
  	}
  }

  function doWeb(doc, url) {
  	var newItems = new Array();
  	var needFullItems = new Array();
  	var couldUseFullItems = new Array();
  	
  	
  	// See note in detectWeb()
  	function nsResolver() {
  		return 'http://www.w3.org/1999/xhtml';
  	}
  	
  	var spans = doc.evaluate('//x:span[contains(@class, " Z3988") or contains(@class, "Z3988 ") or @class="Z3988"][@title]', doc, nsResolver, XPathResult.ANY_TYPE, null);
  	var span;
  	while(span = spans.iterateNext()) {
  		var spanTitle = span.title;
  		var newItem = new Zotero.Item();
  		newItem.repository = false;	// do not save repository
  		if(Zotero.Utilities.parseContextObject(spanTitle, newItem)) {
  			if(newItem.title) {
  				if(!newItem.creators.length) {
  					// if we have a title but little other identifying
  					// information, say we'll get full item later
  					newItem.contextObject = spanTitle;
  					couldUseFullItems[newItems.length] = true;
  				}
  				
  				// title and creators are minimum data to avoid looking up
  				newItems.push(newItem);
  			} else {
  				// retrieve full item
  				newItem.contextObject = spanTitle;
  				needFullItems.push(newItem);
  			}
  		}
  	}
  	
  	Zotero.debug(needFullItems);
  	if(needFullItems.length) {
  		// retrieve full items asynchronously
  		Zotero.wait();
  		retrieveNextCOinS(needFullItems, newItems, couldUseFullItems, doc);
  	} else {
  		completeCOinS(newItems, couldUseFullItems, doc);
  	}
  }

  function doExport() {
  	var item;
  	var co;
  	
  	while (item = Zotero.nextItem()) {
  		co = Zotero.Utilities.createContextObject(item, "1.0");
  		if(co) {
  			Zotero.write("<span class='Z3988' title='"+ Zotero.Utilities.htmlSpecialChars(co) +"'></span>\n");
  		}
  	}
  }
  /** BEGIN TEST CASES **/
  var testCases = [
  	{
  		"type": "web",
  		"url": "http://www.husdal.com/2011/06/19/disruptions-in-supply-networks/",
  		"items": [
  			{
  				"itemType": "journalArticle",
  				"creators": [
  					{
  						"firstName": "Phil",
  						"lastName": "Greening",
  						"creatorType": "author"
  					},
  					{
  						"firstName": "Christine",
  						"lastName": "Rutherford",
  						"creatorType": "author"
  					}
  				],
  				"notes": [],
  				"tags": [],
  				"seeAlso": [],
  				"attachments": [
  					{}
  				],
  				"publicationTitle": "International Journal of Logistics Management",
  				"title": "Disruptions and supply networks: a multi-level, multi-theoretical relational perspective",
  				"date": "2011",
  				"volume": "22",
  				"issue": "1",
  				"pages": "104-126",
  				"libraryCatalog": false,
  				"shortTitle": "Disruptions and supply networks"
  			}
  		]
  	},
  	{
  		"type": "web",
  		"url": "http://gamblershouse.wordpress.com/2011/06/19/the-view-from-dolores/",
  		"items": "multiple"
  	},
  	{
  		"type": "web",
  		"url": "http://www.hubmed.org/display.cgi?uids=21665052",
  		"items": [
  			{
  				"itemType": "journalArticle",
  				"creators": [
  					{
  						"creatorType": "author",
  						"firstName": "Hui-Wen Vivian",
  						"lastName": "Tang"
  					}
  				],
  				"notes": [],
  				"tags": [],
  				"seeAlso": [],
  				"attachments": [
  					{
  						"document": {
  							"location": {}
  						}
  					}
  				],
  				"publicationTitle": "Evaluation and Program Planning",
  				"volume": "34",
  				"issue": "4",
  				"ISSN": "01497189",
  				"date": "11/2011",
  				"pages": "343-352",
  				"DOI": "10.1016/j.evalprogplan.2011.04.002",
  				"url": "http://linkinghub.elsevier.com/retrieve/pii/S0149718911000449",
  				"title": "Optimizing an immersion ESL curriculum using analytic hierarchy process",
  				"libraryCatalog": "CrossRef",
  				"accessDate": "CURRENT_TIMESTAMP"
  			}
  		]
  	}
  ]
  /** END TEST CASES **/


leafName: CSIRO Publishing.js
translatorJSON:
  {
  	"translatorID": "303c2744-ea37-4806-853d-e1ca67be6818",
  	"translatorType": 4,
  	"label": "CSIRO Publishing",
  	"creator": "Michael Berkowitz",
  	"target": "^https?://(www.)?publish\\.csiro\\.au/",
  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-09-17 23:30:00"
  }


leafName: CSL JSON.js
translatorJSON:
  {
  	"translatorID": "bc03b4fe-436d-4a1f-ba59-de4d2d7a63f7",
  	"translatorType": 3,
  	"label": "CSL JSON",
  	"creator": "Simon Kornblith",
  	"target": "json",
  	"minVersion": "3.0b3",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcs",
  	"lastUpdated": "2012-07-11 16:55:00"
  }


leafName: Cyberpresse.js
translatorJSON:
  {
  	"translatorID": "dbfcaa3e-082a-45a4-9619-9892f49399c1",
  	"translatorType": 4,
  	"label": "Cyberpresse",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://(www|recherche)\\.(cyberpresse|lapresse)\\.ca",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsib",
  	"lastUpdated": "2012-05-04 05:25:00"
  }


leafName: dhistory.js
translatorJSON:
  {
  	"translatorID": "946ddf3a-74ca-4309-9917-85aa30297f4c",
  	"translatorType": 4,
  	"label": "dhistory",
  	"creator": "Tim Sherratt",
  	"target": "http://(www\\.)?dhistory\\.org/archives/naa/items/\\d+",
  	"minVersion": "2.1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsbv",
  	"lastUpdated": "2012-08-27 02:40:00"
  }


leafName: Digital Humanities Quarterly.js
translatorJSON:
  {
  	"translatorID": "bbad0221-134b-495a-aa56-d77cfaa67ab5",
  	"translatorType": 4,
  	"label": "Digital Humanities Quarterly",
  	"creator": "Michael Berkowitz",
  	"target": "^https?://(www\\.)?digitalhumanities\\.org/(dhq)?",
  	"minVersion": "1.0.0b4.r5",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-09-21 02:55:00"
  }


leafName: Education Week.js
translatorJSON:
  {
  	"translatorID": "7e51d3fb-082e-4063-8601-cda08f6004a3",
  	"translatorType": 4,
  	"label": "Education Week",
  	"creator": "Ben Parr",
  	"target": "^https?://(?:www\\.|blogs\\.|www2\\.)?edweek",
  	"minVersion": "1.0.0b4.r1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2012-08-06 19:30:00"
  }


leafName: EIDR.js
translatorJSON:
  {
  	"translatorID": "79c3d292-0afc-42a1-bd86-7e706fc35aa5",
  	"translatorType": 8,
  	"label": "EIDR",
  	"creator": "Aurimas Vinckevicius",
  	"target": null,
  	"minVersion": "1.0",
  	"maxVersion": null,
  	"priority": 80,
  	"inRepository": true,
  	"browserSupport": "gcsi",
  	"lastUpdated": "2012-04-19 03:00:00"
  }


leafName: Emerald Publishing.js
translatorJSON:
  {
  	"translatorID": "79f6f9ed-537a-4d4f-8270-c4fbaafdf327",
  	"translatorType": 4,
  	"label": "Emerald Publishing",
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  	"translatorID": "2a5dc3ed-ee5e-4bfb-baad-36ae007e40ce",
  	"translatorType": 4,
  	"label": "DeGruyter",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://www\\.degruyter\\.com",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsib",
  	"lastUpdated": "2014-04-21 18:50:00"
  }


leafName: Delpher.js
translatorJSON:
  {
  	"translatorID": "c4008cc5-9243-4d13-8b35-562cdd184558",
  	"translatorType": 4,
  	"label": "Delpher",
  	"creator": "Hieke Huistra, Thijs Kinkhorst",
  	"target": "^https?://[^\\/]+\\.delpher\\.nl",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsib",
  	"lastUpdated": "2014-03-29 16:15:00"
  }


leafName: DEPATISnet.js
translatorJSON:
  {
  	"translatorID": "d76fea32-fe20-4c00-b5b9-bea8c688c2b0",
  	"translatorType": 4,
  	"label": "DEPATISnet",
  	"creator": "Klaus Flittner",
  	"target": "^https?://depatisnet\\.dpma\\.de/DepatisNet/depatisnet",
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2014-03-12 04:50:00"
  }


leafName: Der Freitag.js
translatorJSON:
  {
  	"translatorID": "1ab8b9a4-72b5-4ef4-adc8-4956a50718f7",
  	"translatorType": 4,
  	"label": "Der Freitag",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://www\\.freitag\\.de",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2013-09-18 07:20:00"
  }


leafName: Dialnet.js
translatorJSON:
  {
  	"translatorID": "938ccabb-e297-4092-aa15-22b6511bbd0f",
  	"translatorType": 4,
  	"label": "Dialnet",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://dialnet\\.unirioja\\.es/(servlet|buscar)/",
  	"minVersion": "2.1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsbv",
  	"lastUpdated": "2014-02-14 08:15:00"
  }


leafName: Die Zeit.js
translatorJSON:
  {
  	"translatorID": "312bbb0e-bfb6-4563-a33c-085445d391ed",
  	"translatorType": 4,
  	"label": "Die Zeit",
  	"creator": "Martin Meyerhoff",
  	"target": "^https?://www\\.zeit\\.de/",
  	"minVersion": "1.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2014-04-04 02:20:00"
  }


leafName: digibib.net.js
translatorJSON:
  {
  	"translatorID": "e99bd723-39e6-418c-9524-390dbc583e08",
  	"translatorType": 4,
  	"label": "digibib.net",
  	"creator": "Heiko Jansen (hbz), Ingolf Kuss (hbz), Bernhard Assmann (hbz)",
  	"target": "https?://.*\\.digibib\\.net/(Digibib|jumpto|metasearch|opensearch|template)",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcs",
  	"lastUpdated": "2013-02-11 07:25:00"
  }


leafName: Digital Medievalist.js
translatorJSON:
  {
  	"translatorID": "5e684d82-73a3-9a34-095f-19b112d77bbe",
  	"translatorType": 4,
  	"label": "Digital Medievalist",
  	"creator": "Fred Gibbs, Sebastian Karcher",
  	"target": "^https?://digitalmedievalist\\.org/(index\\.html)?($|journal/?$|(journal/[3-9]))",
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2014-03-12 06:30:00"
  }


leafName: DigiZeitschriften.js
translatorJSON:
  {
  	"translatorID": "e46830a2-1b19-4b6b-9f1a-e5e9760a0f80",
  	"translatorType": 4,
  	"label": "DigiZeitschriften",
  	"creator": "Philipp Zumstein",
  	"target": "^https?://www\\.digizeitschriften\\.de/((en/)?dms/|index\\.php\\?id=27[24])",
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsv",
  	"lastUpdated": "2014-05-08 21:45:00"
  }


leafName: dLibra.js
translatorJSON:
  {
  	"translatorID": "915e3ae2-afa9-4b1d-9780-28ed3defe0ab",
  	"translatorType": 4,
  	"label": "dLibra",
  	"creator": "Pawel Kolodziej <p.kolodziej@gmail.com>",
  	"target": "/.*dlibra/(doccontent|docmetadata|collectiondescription|results)|/dlibra/?",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2013-04-17 03:20:00"
  }


leafName: DOI.js
translatorJSON:
  {
  	"translatorID": "c159dcfe-8a53-4301-a499-30f6549c340d",
  	"translatorType": 4,
  	"label": "DOI",
  	"creator": "Simon Kornblith",
  	"target": null,
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 300,
  	"inRepository": true,
  	"browserSupport": "gcsv",
  	"lastUpdated": "2014-02-23 18:35:00"
  }

code:
  {
  	"translatorID": "c159dcfe-8a53-4301-a499-30f6549c340d",
  	"translatorType": 4,
  	"label": "DOI",
  	"creator": "Simon Kornblith",
  	"target": null,
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 300,
  	"inRepository": true,
  	"browserSupport": "gcsv",
  	"lastUpdated": "2014-02-23 18:35:00"
  }

  var items = {};
  var selectArray = {};

  var __num_DOIs;

  // builds a list of DOIs
  function getDOIs(doc) {
  	// TODO Detect DOIs more correctly.
  	// The actual rules for DOIs are very lax-- but we're more strict.
  	// Specifically, we should allow space characters, and all Unicode
  	// characters except for control characters. Here, we're cheating
  	// by not allowing ampersands, to fix an issue with getting DOIs
  	// out of URLs.
  	// Description at: http://www.doi.org/handbook_2000/appendix_1.html#A1-4
  	const DOIre = /\b10\.[0-9]{4,}\/[^\s&]*[^\s\&\.,]/g;
  	const DOIXPath = "//text()[contains(., '10.')]\
  						[not(parent::script or parent::style)]";

  	var DOIs = [];

  	var node, m, DOI;
  	var results = doc.evaluate(DOIXPath, doc, null, XPathResult.ANY_TYPE, null);
  	while(node = results.iterateNext()) {
  		//Z.debug(node.nodeValue)
  		DOIre.lastMatch = 0;
  		while(m = DOIre.exec(node.nodeValue)) {
  			DOI = m[0];
  			if(DOI.substr(-1) == ")" && DOI.indexOf("(") == -1) {
  				DOI = DOI.substr(0, DOI.length-1);
  			}
  			// only add new DOIs
  			if(DOIs.indexOf(DOI) == -1) {
  				DOIs.push(DOI);
  			}
  		}
  	}

  	return DOIs;
  }

  function detectWeb(doc, url) {
  	// Blacklist the advertising iframe in ScienceDirect guest mode:
  	// http://www.sciencedirect.com/science/advertisement/options/num/264322/mainCat/general/cat/general/acct/...
  	// This can be removed from blacklist when 5c324134c636a3a3e0432f1d2f277a6bc2717c2a hits all clients (Z 3.0+)
  	const blacklistRe = /^https?:\/\/[^/]*(?:google\.com|sciencedirect\.com\/science\/advertisement\/)/i;
  	
  	if(!blacklistRe.test(url)) {
  		var DOIs = getDOIs(doc);
  		if(DOIs.length) {
  			return DOIs.length == 1 ? "journalArticle" : "multiple";
  		}
  	}
  	return false;
  }

  function completeDOIs(doc) {
  	// all DOIs retrieved now
  	// check to see if there is more than one DOI
  	var numDOIs = 0;
  	for(var DOI in selectArray) {
  		numDOIs++;
  		if(numDOIs == 2) break;
  	}
  	if(numDOIs == 0) {
  		throw "DOI Translator: could not find DOI";
  	} else if(numDOIs == 1) {
  		// do we want to add URL of the page?
  		items[DOI].url = doc.location.href;
  		items[DOI].attachments = [{document:doc}];
  		items[DOI].complete();
  	} else {
  		Zotero.selectItems(selectArray, function(selectedDOIs) {
  			if(!selectedDOIs) return true;

  			for(var DOI in selectedDOIs) {
  				items[DOI].complete();
  			}
  		});
  	}
  }

  function retrieveDOIs(DOIs, doc) {
  	__num_DOIs = DOIs.length;

  	for(var i=0, n=DOIs.length; i<n; i++) {
  		(function(doc, DOI) {
  			var translate = Zotero.loadTranslator("search");
  			translate.setTranslator("11645bd1-0420-45c1-badb-53fb41eeb753");
  	
  			var item = {"itemType":"journalArticle", "DOI":DOI};
  			translate.setSearch(item);
  	
  			// don't save when item is done
  			translate.setHandler("itemDone", function(translate, item) {
  				item.repository = "CrossRef";
  				items[DOI] = item;
  				selectArray[DOI] = item.title;
  			});
  	
  			translate.setHandler("done", function(translate) {
  				__num_DOIs--;
  				if(__num_DOIs <= 0) {
  					completeDOIs(doc);
  				}
  			});
  	
  			// Don't throw on error
  			translate.setHandler("error", function() {});
  	
  			translate.translate();
  		})(doc, DOIs[i]);
  	}
  }

  function doWeb(doc, url) {
  	var DOIs = getDOIs(doc);

  	// retrieve full items asynchronously
  	retrieveDOIs(DOIs, doc);
  }


  /** BEGIN TEST CASES **/
  var testCases = [
  	{
  		"type": "web",
  		"url": "http://blog.apastyle.org/apastyle/digital-object-identifier-doi/",
  		"items": "multiple"
  	},
  	{
  		"type": "web",
  		"url": "http://libguides.csuchico.edu/citingbusiness",
  		"items": [
  			{
  				"itemType": "journalArticle",
  				"creators": [
  					{
  						"creatorType": "author",
  						"firstName": "Jean M.",
  						"lastName": "Twenge"
  					},
  					{
  						"creatorType": "author",
  						"firstName": "Stacy M.",
  						"lastName": "Campbell"
  					}
  				],
  				"notes": [],
  				"tags": [],
  				"seeAlso": [],
  				"attachments": [
  					{}
  				],
  				"publicationTitle": "Journal of Managerial Psychology",
  				"volume": "23",
  				"issue": "8",
  				"language": "en",
  				"ISSN": "0268-3946",
  				"date": "2008",
  				"pages": "862-877",
  				"DOI": "10.1108/02683940810904367",
  				"url": "http://libguides.csuchico.edu/citingbusiness",
  				"title": "Generational differences in psychological traits and their impact on the workplace",
  				"libraryCatalog": "CrossRef",
  				"accessDate": "CURRENT_TIMESTAMP"
  			}
  		]
  	}
  ]
  /** END TEST CASES **/


leafName: Douban.js
translatorJSON:
  {
  	"translatorID": "fc353b26-8911-4c34-9196-f6f567c93901",
  	"translatorType": 4,
  	"label": "Douban",
  	"creator": "Ace Strong<acestrong@gmail.com>",
  	"target": "^https?://(?:www|book).douban.com/(?:subject|doulist|people/[a-zA-Z._]*/(?:do|wish|collect)|.*?status=(?:do|wish|collect)|group/[0-9]*?/collection|tag)",
  	"minVersion": "2.0rc1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2013-05-13 01:50:00"
  }


leafName: DPLA.js
translatorJSON:
  {
  	"translatorID": "117feb72-21bb-4424-a47b-c9ca6b71f979",
  	"translatorType": 4,
  	"label": "DPLA",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://dp\\.la/",
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcv",
  	"lastUpdated": "2013-10-24 17:20:00"
  }


leafName: DrugBank.ca.js
translatorJSON:
  {
  	"translatorID": "b2a735f3-11ac-4e9f-b22b-00e1b1d3c9f6",
  	"translatorType": 4,
  	"label": "DrugBank.ca",
  	"creator": "Tom Hodder <tom@limepepper.co.uk>",
  	"target": "^https?://(?:www\\.)?drugbank.ca/drugs/",
  	"minVersion": "2.1.9",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2014-03-12 06:20:00"
  }


leafName: DTU Orbit.js
translatorJSON:
  {
  	"translatorID": "097c963e-3866-4c6f-a6b4-f5e9d0d15530",
  	"translatorType": 4,
  	"label": "DTU Orbit",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://orbit\\.dtu\\.dk/",
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcbv",
  	"lastUpdated": "2013-06-01 20:55:00"
  }


leafName: Early English Books Online.js
translatorJSON:
  {
  	"translatorID": "b86bb082-6310-4772-a93c-913eaa3dfa1b",
  	"translatorType": 4,
  	"label": "Early English Books Online",
  	"creator": "Michael Berkowitz",
  	"target": "^https?://[^/]*eebo\\.chadwyck\\.com[^/]*(/works)?/search",
  	"minVersion": "2.1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsb",
  	"lastUpdated": "2014-04-04 02:20:00"
  }


leafName: ebrary.js
translatorJSON:
  {
  	"translatorID": "2abe2519-2f0a-48c0-ad3a-b87b9c059459",
  	"translatorType": 4,
  	"label": "ebrary",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://site\\.ebrary\\.com/.+(?:docDetail|search)\\.action\\?",
  	"minVersion": "4.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcv",
  	"lastUpdated": "2014-03-17 20:05:00"
  }


leafName: EBSCOhost.js
translatorJSON:
  {
  	"translatorID": "d0b1914a-11f1-4dd7-8557-b32fe8a3dd47",
  	"translatorType": 4,
  	"label": "EBSCOhost",
  	"creator": "Simon Kornblith, Michael Berkowitz, Josh Geller",
  	"target": "^https?://[^/]+/(?:eds|bsi|ehost)/(?:results|detail|folder|pdfviewer)",
  	"minVersion": "2.1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsib",
  	"lastUpdated": "2014-02-17 04:15:00"
  }


leafName: Edinburgh University Press Journals.js
translatorJSON:
  {
  	"translatorID": "b7bd798d-e518-46d1-aa13-a69f2864fa91",
  	"translatorType": 4,
  	"label": "Edinburgh University Press Journals",
  	"creator": "Sebastian Karcher",
  	"target": "^https?://www\\.euppublishing\\.com/",
  	"minVersion": "3.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2013-01-22 03:10:00"
  }


leafName: Electronic Colloquium on Computational Complexity.js
translatorJSON:
  {
  	"translatorID": "09a9599e-c20e-a405-d10d-35ad4130a426",
  	"translatorType": 4,
  	"label": "Electronic Colloquium on Computational Complexity",
  	"creator": "Jonas Schrieb",
  	"target": "^https?://(www\\.)?eccc\\.(uni-trier|hpi-web)\\.de/",
  	"minVersion": "1.0.0b3.r1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsib",
  	"lastUpdated": "2014-04-04 02:20:00"
  }


leafName: eLibrary.ru.js
translatorJSON:
  {
  	"translatorID": "587709d3-80c5-467d-9fc8-ed41c31e20cf",
  	"translatorType": 4,
  	"label": "eLibrary.ru",
  	"creator": "Avram Lyon",
  	"target": "^https?://elibrary\\.ru/",
  	"minVersion": "2.1",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsbv",
  	"lastUpdated": "2014-04-04 02:20:00"
  }


leafName: eLife.js
translatorJSON:
  {
  	"translatorID": "98ad3ad1-9d43-4b2e-bc36-172cbf00ba1d",
  	"translatorType": 4,
  	"label": "eLife",
  	"creator": "Aurimas Vinckevicius",
  	"target": "https?://elife.elifesciences.org/(?:content/|elife/search\\?|category/|browse)",
  	"minVersion": "4.0",
  	"maxVersion": null,
  	"priority": 100,
  	"inRepository": true,
  	"browserSupport": "gcsbv",
  	"lastUpdated": "2014-02-24 07:50:00"
  }


leafName: Elsevier Health Journals.js
translatorJSON:
  {
  	"translatorID": "b043e7ed-b921-4444-88af-2fcc39881ee2",
  	"translatorType": 4,
  	"label": "Elsevier Health Journals",
  	"creator": "Sebastian Karcher",
  	"target": "/search/(quick|results)$|/article/[^/]+/(abstract|fulltext|references|images)$",
  	"minVersion": "1.0",
  	"maxVersion": null,
  	"priority": 250,
  	"inRepository": true,
  	"browserSupport": "gcsbv",
  	"lastUpdated": "2014-04-03 22:05:00"
  }


leafName: Embedded Metadata.js
translatorJSON:
  {
  	"translatorID": "951c027d-74ac-47d4-a107-9c3069ab7b48",
  	"translatorType": 4,
  	"label": "Embedded Metadata",
  	"creator": "Simon Kornblith and Avram Lyon",
  	"target": null,
  	"minVersion": "3.0.4",
  	"maxVersion": null,
  	"priority": 400,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2014-04-24 05:50:00"
  }

code:
  {
  	"translatorID": "951c027d-74ac-47d4-a107-9c3069ab7b48",
  	"translatorType": 4,
  	"label": "Embedded Metadata",
  	"creator": "Simon Kornblith and Avram Lyon",
  	"target": null,
  	"minVersion": "3.0.4",
  	"maxVersion": null,
  	"priority": 400,
  	"inRepository": true,
  	"browserSupport": "gcsibv",
  	"lastUpdated": "2014-04-24 05:50:00"
  }

  /*
  	***** BEGIN LICENSE BLOCK *****

  	Copyright © 2011 Avram Lyon and the Center for History and New Media
  					 George Mason University, Fairfax, Virginia, USA
  					 http://zotero.org

  	This file is part of Zotero.

  	Zotero is free software: you can redistribute it and/or modify
  	it under the terms of the GNU Affero General Public License as published by
  	the Free Software Foundation, either version 3 of the License, or
  	(at your option) any later version.

  	Zotero is distributed in the hope that it will be useful,
  	but WITHOUT ANY WARRANTY; without even the implied warranty of
  	MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  	GNU Affero General Public License for more details.

  	You should have received a copy of the GNU Affero General Public License
  	along with Zotero.  If not, see <http://www.gnu.org/licenses/>.

  	***** END LICENSE BLOCK *****
  */

  var HIGHWIRE_MAPPINGS = {
  	"citation_title":"title",
  	"citation_publication_date":"date",	//perhaps this is still used in some old implementations
  	"citation_date":"date",
  	"citation_journal_title":"publicationTitle",
  	"citation_journal_abbrev":"journalAbbreviation",
  	"citation_book_title":"bookTitle",
  	"citation_volume":"volume",
  	"citation_issue":"issue",
  	"citation_series_title":"series",
  	"citation_conference_title":"conferenceName",
  	"citation_conference":"conferenceName",
  	"citation_dissertation_institution":"university",
  	"citation_technical_report_institution":"institution",
  	"citation_technical_report_number":"number",
  	"citation_publisher":"publisher",
  	"citation_isbn":"ISBN",
  	"citation_abstract":"abstractNote",
  	"citation_doi":"DOI",
  	"citation_public_url":"url",
  	"citation_language":"language"

  /* the following are handled separately in addHighwireMetadata()
  	"citation_author"
  	"citation_authors"
  	"citation_firstpage"
  	"citation_lastpage"
  	"citation_issn"
  	"citation_eIssn"
  	"citation_pdf_url"
  	"citation_abstract_html_url"
  	"citation_fulltext_html_url"
  	"citation_pmid"
  	"citation_online_date"
  	"citation_year"
  	"citation_keywords"
  */
  };

  // Maps actual prefix in use to URI
  // The defaults are set to help out in case a namespace is not declared
  // Copied from RDF translator
  var _prefixes = {
  	bib:"http://purl.org/net/biblio#",
  	bibo:"http://purl.org/ontology/bibo/",
  	dc:"http://purl.org/dc/elements/1.1/",
  	dcterms:"http://purl.org/dc/terms/",
  	prism:"http://prismstandard.org/namespaces/1.2/basic/",
  	foaf:"http://xmlns.com/foaf/0.1/",
  	vcard:"http://nwalsh.com/rdf/vCard#",
  	link:"http://purl.org/rss/1.0/modules/link/",
  	z:"http://www.zotero.org/namespaces/export#",
  	eprint:"http://purl.org/eprint/terms/",
  	eprints:"http://purl.org/eprint/terms/",
  	og:"http://ogp.me/ns#",				// Used for Facebook's OpenGraph Protocol
  	article:"http://ogp.me/ns/article#",
  	book:"http://ogp.me/ns/book#",
  	rdf:"http://www.w3.org/1999/02/22-rdf-syntax-ns#"
  };

  var _prefixRemap = {
  	//DC should be in lower case
  	"http://purl.org/DC/elements/1.0/": "http://purl.org/dc/elements/1.0/",
  	"http://purl.org/DC/elements/1.1/": "http://purl.org/dc/elements/1.1/"
  };

  var namespaces = {};

  var _rdfPresent = false,
  	_haveItem = false,
  	_itemType;

  var RDF;

  var CUSTOM_FIELD_MAPPINGS;

  function addCustomFields(customFields) {
  	CUSTOM_FIELD_MAPPINGS = customFields;
  }

  function setPrefixRemap(map) {
  	_prefixRemap = map;
  }

  function remapPrefix(uri) {
  	if(_prefixRemap[uri]) return _prefixRemap[uri];
  	return uri;
  }

  function getPrefixes(doc) {
  	var links = doc.getElementsByTagName("link");
  	for(var i=0, link; link = links[i]; i++) {
  		// Look for the schema's URI in our known schemata
  		var rel = link.getAttribute("rel");
  		if(rel) {
  			var matches = rel.match(/^schema\.([a-zA-Z]+)/);
  			if(matches) {
  				var uri = remapPrefix(link.getAttribute("href"));
  				//Zotero.debug("Prefix '" + matches[1].toLowerCase() +"' => '" + uri + "'");
  				_prefixes[matches[1].toLowerCase()] = uri;
  			}
  		}
  	}
  	
  	//also look in html and head elements
  	var prefixes = (doc.documentElement.getAttribute('prefix') || '')
  		+ (doc.head.getAttribute('prefix') || '');
  	var prefixRE = /(\w+):\s+(\S+)/g;
  	var m;
  	while(m = prefixRE.exec(prefixes)) {
  		var uri = remapPrefix(m[2]);
  		Z.debug("Prefix '" + m[1].toLowerCase() +"' => '" + uri + "'");
  		_prefixes[m[1].toLowerCase()] = uri;
  	}
  }

  function getContentText(doc, name, strict) {
  	var xpath = '/x:html/x:head/x:meta[' +
  		(strict?'@name':
  			'substring(@name, string-length(@name)-' + (name.length - 1) + ')') +
  		'="'+ name +'"]/';
  	return ZU.xpathText(doc, xpath + '@content | ' + xpath + '@contents', namespaces);
  }

  function getContent(doc, name, strict) {
  	var xpath = '/x:html/x:head/x:meta[' +
  		(strict?'@name':
  			'substring(@name, string-length(@name)-' + (name.length - 1) + ')') +
  		'="'+ name +'"]/';
  	return ZU.xpath(doc, xpath + '@content | ' + xpath + '@contents', namespaces);
  }

  function fixCase(authorName) {
  	//fix case if all upper or all lower case
  	if(authorName.toUpperCase() === authorName ||
  		authorName.toLowerCase() === authorName) {
  		return ZU.capitalizeTitle(authorName, true);
  	}

  	return authorName;
  }

  function processFields(doc, item, fieldMap, strict) {
  	for(var metaName in fieldMap) {
  		var zoteroName = fieldMap[metaName];
  		var value = getContentText(doc, metaName, strict);
  		if(value && value.trim()) {
  			item[zoteroName] = ZU.trimInternal(value);
  		}
  	}
  }

  function completeItem(doc, newItem) {
  	addHighwireMetadata(doc, newItem);
  	addOtherMetadata(doc, newItem);
  	addLowQualityMetadata(doc, newItem);
  	finalDataCleanup(doc, newItem);

  	if(CUSTOM_FIELD_MAPPINGS) {
  		processFields(doc, newItem, CUSTOM_FIELD_MAPPINGS, true);
  	}
  	
  	newItem.complete();
  }

  function detectWeb(doc, url) {
  	//blacklist wordpress jetpack comment plugin so it doesn't override other metadata
  	if (url.indexOf("jetpack.wordpress.com/jetpack-comment/")!=-1) return false;
  	if(exports.itemType) return exports.itemType;

  	init(doc, url, Zotero.done);
  }

  function init(doc, url, callback, forceLoadRDF) {
  	getPrefixes(doc);

  	var metaTags = doc.head.getElementsByTagName("meta");
  	Z.debug("Embedded Metadata: found " + metaTags.length + " meta tags.");
  	if(forceLoadRDF /* check if this is called from doWeb */ && !metaTags.length) {
  		if(doc.head) {
  			Z.debug(doc.head.innerHTML
  				.replace(/<style[^<]+(?:<\/style>|\/>)/ig, '')
  				.replace(/<link[^>]+>/ig, '')
  				.replace(/(?:\s*[\r\n]\s*)+/g, '\n')
  			);
  		} else {
  			Z.debug("Embedded Metadata: No head tag");
  		}
  	}

  	var hwType, hwTypeGuess, generatorType, statements = [];

  	for(var i=0, metaTag; metaTag = metaTags[i]; i++) {
  		// Two formats allowed:
  		// 	<meta name="..." content="..." />
  		//	<meta property="..." content="..." />
  		// The first is more common; the second is recommended by Facebook
  		// for their OpenGraph vocabulary
  		var tags = metaTag.getAttribute("name");
  		if (!tags) tags = metaTag.getAttribute("property");
  		var value = metaTag.getAttribute("content");
  		if(!tags || !value) continue;

  		tags = tags.split(/\s+/);
  		for(var j=0, m=tags.length; j<m; j++) {
  			var tag = tags[j];
  			// We allow three delimiters between the namespace and the property
  			var delimIndex = tag.search(/[.:_]/);
  			//if(delimIndex === -1) continue;

  			var prefix = tag.substr(0, delimIndex).toLowerCase();

  			if(_prefixes[prefix]) {
  				var prop = tag.substr(delimIndex+1, 1).toLowerCase()+tag.substr(delimIndex+2);
  				
  				//bib and bibo types are special, they use rdf:type to define type
  				var specialNS = [_prefixes['bib'], _prefixes['bibo']];
  				if(prop == 'type' && specialNS.indexOf(_prefixes[prefix]) != -1) {
  					value = _prefixes[prefix] + value;
  					prefix = 'rdf';
  				}
  				
  				// This debug is for seeing what is being sent to RDF
  				//Zotero.debug(_prefixes[prefix]+prop +"=>"+value);
  				statements.push([url, _prefixes[prefix]+prop, value]);
  			} else if(tag.toLowerCase() == 'generator') {
  				var lcValue = value.toLowerCase();
  				if(lcValue.indexOf('blogger') != -1
  					|| lcValue.indexOf('wordpress') != -1
  					|| lcValue.indexOf('wooframework') != -1
  				) {	
  					generatorType = 'blogPost';
  				}
  			} else {
  				var shortTag = tag.slice(tag.lastIndexOf('citation_'));
  				switch(shortTag) {
  					case "citation_journal_title":
  						hwType = "journalArticle";
  						break;
  					case "citation_technical_report_institution":
  						hwType = "report";
  						break;
  					case "citation_conference_title":
  					case "citation_conference":
  						hwType = "conferencePaper";
  						break;
  					case "citation_book_title":
  						hwType = "bookSection";
  						break;
  					case "citation_dissertation_institution":
  						hwType = "thesis";
  						break;
  					case "citation_title":		//fall back to journalArticle, since this is quite common
  					case "citation_series_title":	//possibly journal article, though it could be book
  						hwTypeGuess = "journalArticle";
  						break;
  				}
  			}
  		}
  	}
  	
  	if(statements.length || forceLoadRDF) {
  		// load RDF translator, so that we don't need to replicate import code
  		var translator = Zotero.loadTranslator("import");
  		translator.setTranslator("5e3ad958-ac79-463d-812b-a86a9235c28f");
  		translator.setHandler("itemDone", function(obj, newItem) {
  			_haveItem = true;
  			completeItem(doc, newItem);
  		});
  		
  		translator.getTranslatorObject(function(rdf) {
  			for(var i=0; i<statements.length; i++) {
  				var statement = statements[i];			
  				rdf.Zotero.RDF.addStatement(statement[0], statement[1], statement[2], true);
  			}

  			var nodes = rdf.getNodes(true);
  			rdf.defaultUnknownType = hwType || hwTypeGuess || generatorType ||
  				//if we have RDF data, then default to webpage
  				(nodes.length ? "webpage":false);

  			//if itemType is overridden, no reason to run RDF.detectWeb
  			if(exports.itemType) {
  				rdf.itemType = exports.itemType;
  				_itemType = exports.itemType;
  			} else {
  				_itemType = nodes.length ? rdf.detectType({},nodes[0],{}) : rdf.defaultUnknownType;
  			}

  			RDF = rdf;
  			callback(_itemType);
  		});
  	} else {
  		callback(exports.itemType || hwType || hwTypeGuess || generatorType);
  	}
  }

  function doWeb(doc, url) {
  	//set default namespace
  	namespaces.x = doc.documentElement.namespaceURI;
  	// populate _rdfPresent, _itemType, and _prefixes
  	if(!RDF) init(doc, url, function() { importRDF(doc, url) }, true);
  	else importRDF(doc, url);
  }

  //perform RDF import
  function importRDF(doc, url) {
  	RDF.doImport();
  	if(!_haveItem) {
  		completeItem(doc, new Zotero.Item(_itemType));
  	}
  }

  /**
   * Adds HighWire metadata and completes the item
   */
  function addHighwireMetadata(doc, newItem) {
  	// HighWire metadata
  	processFields(doc, newItem, HIGHWIRE_MAPPINGS);

  	var authorNodes = getContent(doc, 'citation_author')
  						.concat(getContent(doc, 'citation_authors'));
  	//save rdfCreators for later
  	var rdfCreators = newItem.creators;
  	newItem.creators = [];
  	for(var i=0, n=authorNodes.length; i<n; i++) {
  		var authors = authorNodes[i].nodeValue.split(/\s*;\s*/);
  		if (authors.length == 1) {
  			/* If we get nothing when splitting by semicolon, and at least two words on
  			* either side of the comma when splitting by comma, we split by comma. */
  			var authorsByComma = authors[0].split(/\s*,\s*/);
  			if (authorsByComma.length > 1
  				&& authorsByComma[0].indexOf(" ") !== -1
  				&& authorsByComma[1].indexOf(" ") !== -1)
  				authors = authorsByComma;
  		}
  		for(var j=0, m=authors.length; j<m; j++) {
  			var author = authors[j].trim();

  			//skip empty authors. Try to match something other than punctuation
  			if(!author || !author.match(/[^\s,-.;]/)) continue;

  			author = ZU.cleanAuthor(author, "author", author.indexOf(",") !== -1);
  			if(author.firstName) {
  				//fix case for personal names
  				author.firstName = fixCase(author.firstName);
  				author.lastName = fixCase(author.lastName);
  			}
  			newItem.creators.push(author);
  		}
  	}

  	if( !newItem.creators.length ) {
  		newItem.creators = rdfCreators;
  	} else if(rdfCreators.length) {
  		//try to use RDF creator roles to update the creators we have
  		for(var i=0, n=newItem.creators.length; i<n; i++) {
  			var name = newItem.creators[i].firstName +
  				newItem.creators[i].lastName;
  			for(var j=0, m=rdfCreators.length; j<m; j++) {
  				var creator = rdfCreators[j];
  				if( name.toLowerCase() == (creator.firstName + creator.lastName).toLowerCase() ) {
  					//highwire should set all to author, so we only care about editor
  					//contributor is not always a contributor
  					if(creator.creatorType == 'editor') {
  						newItem.creators[i].creatorType == creator.creatorType;
  					}
  					rdfCreators.splice(j,1);
  					break;
  				}
  			}
  		}

  		/* This may introduce duplicates
  		//if there are leftover creators from RDF, we should use them
  		if(rdfCreators.length) {
  			for(var i=0, n=rdfCreators.length; i<n; i++) {
  				newItem.creators.push(rdfCreators[i]);
  			}
  		}*/
  	}

  	//Deal with tags in a string
  	//we might want to look at the citation_keyword metatag later
  	if(!newItem.tags || !newItem.tags.length) {
  		var tags = getContent(doc, 'citation_keywords');
  		newItem.tags = [];
  		for(var i=0; i<tags.length; i++) {
  			var tag = tags[i].textContent.trim();
  			if(tag) {
  				var splitTags = tag.split(';');
  				for(var j=0; j<splitTags.length; j++) {
  					if(!splitTags[j].trim()) continue;
  					newItem.tags.push(splitTags[j].trim());
  				}
  			}
  		}
  	}

  	//sometimes RDF has more info, let's not drop it
  	var rdfPages = (newItem.pages)? newItem.pages.split(/\s*-\s*/) : new Array();
  	var firstpage = getContentText(doc, 'citation_firstpage') ||
  					rdfPages[0];
  	var lastpage = getContentText(doc, 'citation_lastpage') ||
  					rdfPages[1];
  	if(firstpage && ( firstpage = firstpage.trim() )) {
  		newItem.pages = firstpage +
  			( ( lastpage && ( lastpage = lastpage.trim() ) )?'-' + lastpage : '' );
  	}
  	
  	//fall back to some other date options
  	if(!newItem.date) {
  		newItem.date = getContentText(doc, 'citation_online_date')
  			|| getContentText(doc, 'citation_year');
  	}
  	
  	//prefer ISSN over eISSN
  	var issn = getContentText(doc, 'citation_issn') ||
  			getContentText(doc, 'citation_eIssn');

  	if(issn) newItem.ISSN = issn;

  	//This may not always yield desired results
  	//i.e. if there is more than one pdf attachment (not common)
  	var pdfURL = getContent(doc, 'citation_pdf_url');
  	if(pdfURL.length) {
  		pdfURL = pdfURL[0].textContent;
  		//delete any pdf attachments if present
  		//would it be ok to just delete all attachments??
  		for(var i=0, n=newItem.attachments.length; i<n; i++) {
  			if(newItem.attachments[i].mimeType == 'application/pdf') {
  				delete newItem.attachments[i];
  			}
  		}

  		newItem.attachments.push({title:"Full Text PDF", url:pdfURL, mimeType:"application/pdf"});
  	}
  	
  	//add snapshot
  	newItem.attachments.push({document:doc, title:"Snapshot"});
  	
  	//store PMID in Extra and as a link attachment
  	//e.g. http://www.sciencemag.org/content/332/6032/977.full
  	var PMID = getContentText(doc, 'citation_pmid');
  	if(PMID) {
  		if(newItem.extra) newItem.extra += '\n';
  		else newItem.extra = '';
  		
  		newItem.extra += 'PMID: ' + PMID;
  		
  		newItem.attachments.push({
  			title: "PubMed entry",
  			url: "http://www.ncbi.nlm.nih.gov/pubmed/" + PMID,
  			mimeType: "text/html",
  			snapshot: false
  		});
  	}

  	// Other last chances
  	if(!newItem.url) {
  		newItem.url = getContentText(doc, "citation_abstract_html_url") ||
  			getContentText(doc, "citation_fulltext_html_url");
  	}
  }

  function addOtherMetadata(doc, newItem) {
  	// Scrape parsely metadata http://parsely.com/api/crawler.html
  	var parselyJSON = ZU.xpathText(doc, '(//x:meta[@name="parsely-page"]/@content)[1]', namespaces);
  	if(parselyJSON) {
  		try {
  			var parsely = JSON.parse(parselyJSON);
  		} catch(e) {}
  		
  		if(parsely) {
  			if(!newItem.title && parsely.title) {
  				newItem.title = parsely.title;
  			}
  			
  			if(!newItem.url && parsely.url) {
  				newItem.url = parsely.url;
  			}
  			
  			if(!newItem.date && parsely.pub_date) {
  				var date = new Date(parsely.pub_date);
  				if(!isNaN(date.getUTCFullYear())) {
  					newItem.date = ZU.formatDate({
  						year: date.getUTCFullYear(),
  						month: date.getUTCMonth(),
  						day: date.getUTCDate()
  					}, true);
  				}
  			}
  			
  			if(!newItem.creators.length && parsely.author) {
  				newItem.creators.push(ZU.cleanAuthor(''+parsely.author, 'author'));
  			}
  			
  			if(!newItem.tags.length && parsely.tags && parsely.tags.length) {
  				newItem.tags = parsely.tags;
  			}
  		}
  	}
  }

  function addLowQualityMetadata(doc, newItem) {
  	//if we don't have a creator, look for byline on the page
  	//but first, we're desperate for a title
  	if(!newItem.title) {
  		Z.debug("Title was not found in meta tags. Using document title as title");
  		newItem.title = doc.title;
  	}
  	
  	if(newItem.title) {
  		newItem.title = newItem.title.replace(/\s+/g, ' '); //make sure all spaces are \u0020
  		if(newItem.publicationTitle) {
  			//remove publication title from the end of title
  			var removePubTitleRegex = new RegExp('\\s*\\W\\s*'
  				+ newItem.publicationTitle + '\\s*$','i');
  			newItem.title = newItem.title.replace(removePubTitleRegex, '');
  		}
  	}
  	
  	if(!newItem.creators.length) getAuthorFromByline(doc, newItem);
  	
  	//fall back to "keywords"
  	if(!newItem.tags.length) {
  		 newItem.tags = ZU.xpath(doc, '//x:meta[@name="keywords"]/@content', namespaces)
  		 	.map(function(t) { return t.textContent; });
  	}
  	
  	//We can try getting abstract from 'description'
  	if(!newItem.abstractNote) {
  		newItem.abstractNote = ZU.trimInternal(
  			ZU.xpathText(doc, '//x:meta[@name="description"]/@content', namespaces) || '');
  	}
  	
  	if(!newItem.url) {
  		newItem.url = doc.location.href;
  	}
  	
  	newItem.libraryCatalog = doc.location.host;
  	
  	// add access date
  	newItem.accessDate = 'CURRENT_TIMESTAMP';
  }

  function getAuthorFromByline(doc, newItem) {
  	var bylineClasses = ['byline', 'vcard'];
  	Z.debug("Looking for authors in " + bylineClasses.join(', '));
  	var bylines = [], byline;
  	for(var i=0; i<bylineClasses.length; i++) {
  		byline = doc.getElementsByClassName(bylineClasses[i]);
  		Z.debug("Found " + byline.length + " elements with '" + bylineClasses[i] + "' class");
  		for(var j=0; j<byline.length; j++) {
  			bylines.push(byline[j]);
  		}
  	}
  	
  	var actualByline;
  	if(!bylines.length) {
  		Z.debug("No byline found.");
  		return;
  	} else if(bylines.length == 1) {
  		actualByline = bylines[0];
  	} else if(newItem.title) {
  		Z.debug(bylines.length + " bylines found. Locating the one closest to title.")
  		//find the closest one to the title (in DOM)
  		actualByline = false;
  		var parentLevel = 1;
  		var skipList = [];
  		
  		// Wrap title in quotes so we can use it in the xpath
  		var xpathTitle = newItem.title;
  		if(xpathTitle.indexOf('"') != -1) {
  			if(xpathTitle.indexOf("'") == -1) {
  				// We can just use single quotes then
  				xpathTitle = "'" + xpathTitle + "'";
  			} else {
  				// Escaping double quotes in xpaths is really hard
  				// Solution taken from http://kushalm.com/the-perils-of-xpath-expressions-specifically-escaping-quotes
  				xpathTitle = 'concat("' + xpathTitle.replace(/"+/g, '",\'$&\', "') + '")';
  			}
  		} else {
  			xpathTitle = '"' + xpathTitle + '"';
  		}
  		
  		var titleXPath = './/*[normalize-space(translate(text(),"\u00a0"," "))='
  			+ xpathTitle + ']';
  		Z.debug("Looking for title using: " + titleXPath);
  		while(!actualByline && bylines.length != skipList.length && parentLevel < 5) {
  			Z.debug("Parent level " + parentLevel);
  			for(var i=0; i<bylines.length; i++) {
  				if(skipList.indexOf(i) !== -1) continue;
  				
  				if(parentLevel == 1) {
  					//skip bylines that contain bylines
  					var containsBylines = false;
  					for(var j=0;!containsBylines && j<bylineClasses.length; j++) {
  						containsBylines = bylines[i].getElementsByClassName(bylineClasses[j]).length;
  					}
  					if(containsBylines) {
  						Z.debug("Skipping potential byline " + i + ". Contains other bylines");
  						skipList.push(i);
  						continue;
  					}
  				}
  				
  				var bylineParent = bylines[i];
  				for(var j=0; j<parentLevel; j++) {
  					bylineParent = bylineParent.parentElement;
  				}
  				if(!bylineParent) {
  					Z.debug("Skipping potential byline " + i + ". Nowhere near title");
  					skipList.push(i);
  					continue;
  				}
  				
  				if(ZU.xpath(bylineParent, titleXPath).length) {
  					if(actualByline) {
  						//found more than one, bail
  						Z.debug('More than one possible byline found. Will not proceed');
  						return;
  					}
  					actualByline = bylines[i];
  				}
  			}
  			
  			parentLevel++;
  		}
  	}
  	
  	if(actualByline) {
  		byline = ZU.trimInternal(actualByline.textContent);
  		Z.debug("Extracting author(s) from byline: " + byline);
  		byline = byline.split(/\bby[:\s]+/i);
  		byline = byline[byline.length-1].replace(/\s*[[(].+?[)\]]\s*/g, '');
  		var authors = byline.split(/\s*(?:(?:,\s*)?and|,|&)\s*/i);
  		if(authors.length == 2 && authors[0].split(' ').length == 1) {
  			//this was probably last, first
  			newItem.creators.push(ZU.cleanAuthor(fixCase(byline), 'author', true));
  		} else {
  			for(var i=0, n=authors.length; i<n; i++) {
  				if(!authors[i].length || authors[i].indexOf('@') !== -1) {
  					//skip some odd splits and twitter handles
  					continue;
  				}
  				
  				if(authors[i].split(/\s/).length == 1) {
  					//probably corporate author
  					newItem.creators.push({
  						lastName: authors[i],
  						creatorType: 'author',
  						fieldMode: 1
  					});
  				} else {
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  				"notes": [],
  				"tags": [
  					"huelga",
  					"trabajadores",
  					"trabajadroras",
  					"relaciones de género"
  				],
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  				"title": "\"La Huelga de los Conventillos\", Buenos Aires, Nueva Pompeya, 1936. Un aporte a los estudios sobre género y clase",
  				"publicationTitle": "A Contracorriente",
  				"rights": "1. Author hereby grants, transfers, and assigns to  A Contracorriente :  (a) the exclusive first serial rights in the Work for publication and distribution throughout the world, as  A Contracorriente  sees fit, in all languages and formats, by print or any electronic means, including, without limitation, the internet, other public and/or private proprietary intranets and computer networks and on CD-ROMs, DVDs and other discs, before the Work shall appear in any other publication (whether print or electronic), in any manner, format or language, or in any other medium now known or hereafter devised. The first serial rights granted to  A Contracorriente  by this Paragraph 1(a) shall be exclusive to  A Contracorriente  until one year following the date of the first serial publication of the Work by  A Contracorriente ; in addition, this grant of rights shall include the non-exclusive right in perpetuity to include the Work in any collection, or compilation produced or authorized by  A Contracorriente , and containing at least 75% material that has appeared in  A Contracorriente , for distribution throughout the world, in all languages and formats, by print or any electronic means, including, without limitation, the internet and other public and proprietary intranets and computer networks and on CDROMs, DVDs and other discs;  (b) further, the non-exclusive right to authorize, reproduce and distribute reprints of the Work throughout the world, in all languages and formats, by print or any electronic means, after the Work appears in a publication produced or authorized by  A Contracorriente ; the right to permit subscribers and other users of the services and publications in which the Work may appear electronically to download, reproduce, and otherwise utilize the Work for their personal, non-commercial use throughout the universe; and the non-exclusive perpetual right, throughout the world, to use the Work, in whole or in part, and Author’s name, likeness, or biography in promoting, advertising, and/or publicizing any publication in which the Work is authorized to appear consistent with this Agreement.  2.  A Contracorriente  reserves the right to publish the Work with illustrations and other graphic materials. Nothing contained herein shall obligate  A Contracorriente  to exploit any of the rights granted to  A Contracorriente  hereunder. All rights not granted to  A Contracorriente  are reserved to Author for Author’s own use and/or transfer, assignment, or disposition.  3. Author represents and warrants: the Work is original to Author, has not been copied in whole or in part, and does not infringe upon the copyright or any other rights of any person or entity; Author has the right to grant the rights granted to  A Contracorriente  under this Agreement free of any and all claims and encumbrances; Author has not granted or transferred any rights in or to the Work to any third party; and Author has not done and will not do anything that has impaired, might impair or will impair in any way any of the rights granted to  A Contracorriente  hereunder.  4. Author shall defend, indemnify, and hold harmless the NC State and its employees, agents, affiliates, successors, licensees, and assigns from and against all claims, damages, liabilities, losses, costs, and expenses, including, without limitation, attorney’s fees and costs, arising out of any breach or alleged breach of any of Author’s representations, warranties, or agreements. Any remedies that Author may have against  A Contracorriente  for breach of this Agreement shall be limited to the right to recover damages, if any, in an action at law. Author hereby waives any right or remedy in equity, including any right to terminate this Agreement, to rescind  A Contracorriente ’s rights in the Work, or to enjoin, restrain, or otherwise impair in any manner the production or distribution of any publication that is authorized or produced by  A Contracorriente .   5.  A Contracorriente  shall have the right to assign this Agreement, either in whole or in part, to any entity affiliated with  A Contracorriente  or to any party that acquires all or substantially all of  A Contracorriente 's assets. Author shall not have the right to further assign any of the rights conferred pursuant to this Agreement, either in whole or in part, or any of the rights granted to Author herein.   6. This Agreement is intended by the parties hereto as the final expression of their understanding with respect to the subject matter herein, as a complete and exclusive statement of the terms herein, and supersedes any and all prior or contemporaneous negotiations, understandings, and agreements between the parties relating thereto.   7. The Agreement may be modified only by a writing signed by both parties to the Agreement. The laws and courts of the State of North Carolina shall govern and control the resolution of any and all conflicts and disputes that may arise hereunder.",
  				"date": "10/10/2011",
  				"reportType": "Text.Serial.Journal",
  				"letterType": "Text.Serial.Journal",
  				"manuscriptType": "Text.Serial.Journal",
  				"mapType": "Text.Serial.Journal",
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  				"language": "en",
  				"extra": "Este trabajo se propone realizar un análisis de las   relaciones de género y clase a través de un estudio de caso: la “Huelga de   los Conventillos” de la fábrica textil Gratry en 1936, que se extendió por   más de tres meses, pasando casi inadvertida, sin embargo, para la   investigación histórica. Siendo la textil una rama de industria con una   mayoría de mano de obra femenina, el caso de la casa Gratry, donde el 60% de   los 800 obreros eran mujeres, aparece como ejemplar para la observación de la   actividad de las mujeres en conflicto.   En el trabajo se analiza el rol de las trabajadoras en   la huelga, su participación política, sus formas de organización y   resistencia, haciendo eje en las determinaciones de género y de clase que son   abordadas de manera complementaria e interrelacionada, así como el complejo   entramado de tensiones y solidaridades que éstas generan. De éste modo, se   pretende ahondar en la compleja conformación de una identidad obrera   femenina, a la vez que se discute con aquella mirada historiográfica tradicional   que ha restado importancia a la participación de la mujer en el conflicto   social. Esto se realizará a través de la exploración de una serie de   variables: las relaciones inter-género e inter-clase (fundamentalmente el   vínculo entre las trabajadoras y la patronal masculina), inter-género e   intra-clase (la relación entre trabajadoras y trabajadores), intra-género e   inter-clase (los lazos entre las trabajadoras y las vecinas comerciantes del   barrio), intra-género e intra-clase (relaciones de solidaridad entre   trabajadoras en huelga, y de antagonismo entre huelguistas y “carneras”).   Para ello se trabajó un corpus documental que incluye   información de tipo cuantitativa (las estadísticas del Boletín Informativo   del Departamento Nacional del Trabajo), y cualitativa: periódicos obreros   –fundamentalmente  El Obrero Textil , órgano gremial de la Unión   Obrera Textil,  Semanario de la CGT-Independencia  (órgano de   la Confederación General del Trabajo (CGT)-Independencia) y  La   Vanguardia  (periódico del Partido Socialista), entre otros, y   entrevistas orales a vecinas de Nueva Pompeya y familiares de trabajadoras de   la fábrica Gratry. Se desarrollará una metodología cuali-cuantitativa para el   cruce de estas fuentes.",
  				"volume": "9",
  				"issue": "1",
  				"abstractNote": "\"La Huelga de los Conventillos\", Buenos Aires, Nueva Pompeya, 1936. Un aporte a los estudios sobre género y clase",
  				"pages": "1-37",
  				"ISSN": "1548-7083",
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  		"items": [
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  					{
  						"firstName": "Akinwumi A.",
  						"lastName": "Akinyede",
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  					{
  						"firstName": "Alade",
  						"lastName": "Akintonwa",
  						"creatorType": "author"
  					},
  					{
  						"firstName": "Charles",
  						"lastName": "Okany",
  						"creatorType": "author"
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  					{
  						"firstName": "Olufunsho",
  						"lastName": "Awodele",
  						"creatorType": "author"
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  						"firstName": "Duro C.",
  						"lastName": "Dolapo",
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  						"firstName": "Adebimpe",
  						"lastName": "Adeyinka",
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  					{
  						"firstName": "Ademola",
  						"lastName": "Yusuf",
  						"creatorType": "author"
  					}
  				],
  				"notes": [],
  				"tags": [
  					"HIV patients",
  					"Nigeria",
  					"knowledge",
  					"malaria",
  					"prevention",
  					"treatment"
  				],
  				"seeAlso": [],
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  				"title": "Knowledge, treatment seeking and preventive practices in respect of malaria among patients with HIV at the Lagos University Teaching Hospital",
  				"publicationTitle": "Tanzania Journal of Health Research",
  				"rights": "Copyright for articles published in this journal is retained by the journal.",
  				"date": "2011/10/17",
  				"language": "en",
  				"extra": "The synergistic interaction between Human Immunodeficiency virus (HIV) disease and Malaria makes it mandatory for patients with HIV to respond appropriately in preventing and treating malaria. Such response will help to control the two diseases. This study assessed the knowledge of 495 patients attending the HIV clinic, in Lagos University Teaching Hospital, Nigeria.&nbsp; Their treatment seeking, preventive practices with regards to malaria, as well as the impact of socio &ndash; demographic / socio - economic status were assessed. Out of these patients, 245 (49.5 %) used insecticide treated bed nets; this practice was not influenced by socio &ndash; demographic or socio &ndash; economic factors.&nbsp; However, knowledge of the cause, knowledge of prevention of malaria, appropriate use of antimalarial drugs and seeking treatment from the right source increased with increasing level of education (p &lt; 0.05). A greater proportion of the patients, 321 (64.9 %) utilized hospitals, pharmacy outlets or health centres when they perceived an attack of malaria. Educational intervention may result in these patients seeking treatment from the right place when an attack of malaria fever is perceived.",
  				"volume": "13",
  				"issue": "4",
  				"DOI": "10.4314/thrb.v13i4.63347",
  				"ISSN": "1821 0 9241",
  				"url": "http://www.ajol.info/index.php/thrb/article/view/63347",
  				"abstractNote": "Knowledge, treatment seeking and preventive practices in respect of malaria among patients with HIV at the Lagos University Teaching Hospital",
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  	{
  		"type": "web",
  		"url": "http://scholarworks.umass.edu/climate_nuclearpower/2011/nov19/34/",
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  				"creators": [
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  						"firstName": "Peter",
  						"lastName": "Somssich",
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  				"notes": [],
  				"tags": [],
  				"seeAlso": [],
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  						"title": "Snapshot"
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  				],
  				"title": "Session F: Contributed Oral Papers – F2: Energy, Climate, Nuclear Medicine: Reducing Energy Consumption and CO2 One Street Lamp at a Time",
  				"date": "2011",
  				"conferenceName": "Climate Change and the Future of Nuclear Power",
  				"url": "http://scholarworks.umass.edu/climate_nuclearpower/2011/nov19/34",
  				"abstractNote": "Why wait for federal action on incentives to reduce energy use and address Greenhouse Gas (GHG) reductions (e.g. CO2), when we can take personal actions right now in our private lives and in our communities? One such initiative by private citizens working with Portsmouth NH officials resulted in the installation of energy reducing lighting products on Court St. and the benefits to taxpayers are still coming after over 4 years of operation. This citizen initiative to save money and reduce CO2 emissions, while only one small effort, could easily be duplicated in many towns and cities. Replacing old lamps in just one street fixture with a more energy efficient (Non-LED) lamp has resulted after 4 years of operation ($\\sim $15,000 hr. life of product) in real electrical energy savings of $>$ {\\$}43. and CO2 emission reduction of $>$ 465 lbs. The return on investment (ROI) was less than 2 years. This is much better than any financial investment available today and far safer. Our street only had 30 such lamps installed; however, the rest of Portsmouth (population 22,000) has at least another 150 street lamp fixtures that are candidates for such an upgrade. The talk will also address other energy reduction measures that green the planet and also put more green in the pockets of citizens and municipalities.",
  				"accessDate": "CURRENT_TIMESTAMP",
  				"libraryCatalog": "scholarworks.umass.edu",
  				"shortTitle": "Session F"
  			}
  		]
  	},
  	{
  		"type": "web",
  		"url": "http://scholarworks.umass.edu/lov/vol2/iss1/2/",
  		"items": [
  			{
  				"itemType": "journalArticle",
  				"creators": [
  					{
  						"firstName": "Bonnie D.",
  						"lastName": "Newsom",
  						"creatorType": "author"
  					},
  					{
  						"firstName": "Jamie",
  						"lastName": "Bissonette-Lewey",
  						"creatorType": "author"
  					}
  				],
  				"notes": [],
  				"tags": [
  					"Wabanaki",
  					"Bounty Proclamations",
  					"Decolonization"
  				],
  				"seeAlso": [],
  				"attachments": [
  					{
  						"title": "Full Text PDF",
  						"mimeType": "application/pdf"
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  				],
  				"title": "Wabanaki Resistance and Healing: An Exploration of the Contemporary Role of an Eighteenth Century Bounty Proclamation in an Indigenous Decolonization Process",
  				"date": "2012",
  				"publicationTitle": "Landscapes of Violence",
  				"volume": "2",
  				"issue": "1",
  				"url": "http://scholarworks.umass.edu/lov/vol2/iss1/2",
  				"abstractNote": "The purpose of this paper is to examine the contemporary role of an eighteenth century bounty proclamation issued on the Penobscot Indians of Maine. We focus specifically on how the changing cultural context of the 1755 Spencer Phips Bounty Proclamation has transformed the document from serving as a tool for sanctioned violence to a tool of decolonization for the Indigenous peoples of Maine. We explore examples of the ways indigenous and non-indigenous people use the Phips Proclamation to illustrate past violence directed against Indigenous peoples. This exploration is enhanced with an analysis of the re-introduction of the Phips Proclamation using concepts of decolonization theory.",
  				"pages": "2",
  				"ISSN": "1947-508X",
  				"accessDate": "CURRENT_TIMESTAMP",
  				"libraryCatalog": "scholarworks.umass.edu",
  				"shortTitle": "Wabanaki Resistance and Healing"
  			}
  		]
  	},
  	{
  		"type": "web",
  		"url": "http://scholarworks.umass.edu/open_access_dissertations/508/",
  		"items": [
  			{
  				"itemType": "thesis",
  				"creators": [
  					{
  						"firstName": "Alan Scott",
  						"lastName": "Carlin",
  						"creatorType": "author"
  					}
  				],
  				"notes": [],
  				"tags": [
  					"Agents",
  					"Dec-POMDP",
  					"MDP",
  					"Meta-reasoning",
  					"Multiagent",
  					"Partial Observability"
  				],
  				"seeAlso": [],
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  				"title": "Decision-Theoretic Meta-reasoning in Partially Observable and Decentralized Settings",
  				"date": "2012",
  				"university": "University of Massachusetts - Amherst",
  				"url": "http://scholarworks.umass.edu/open_access_dissertations/508",
  				"abstractNote": "This thesis examines decentralized meta-reasoning. For a single agent or multiple agents, it may not be enough for agents to compute correct decisions if they do not do so in a timely or resource efficient fashion. The utility of agent decisions typically increases with decision quality, but decreases with computation time. The reasoning about one's computation process is referred to as meta-reasoning. Aspects of meta-reasoning considered in this thesis include the reasoning about how to allocate computational resources, including when to stop one type of computation and begin another, and when to stop all computation and report an answer. Given a computational model, this translates into computing how to schedule the basic computations that solve a problem. This thesis constructs meta-reasoning strategies for the purposes of monitoring and control in multi-agent settings, specifically settings that can be modeled by the Decentralized Partially Observable Markov Decision Process (Dec-POMDP). It uses decision theory to optimize computation for efficiency in time and space in communicative and non-communicative decentralized settings. Whereas base-level reasoning describes the optimization of actual agent behaviors, the meta-reasoning strategies produced by this thesis dynamically optimize the computational resources which lead to the selection of base-level behaviors.",
  				"accessDate": "CURRENT_TIMESTAMP",
  				"libraryCatalog": "scholarworks.umass.edu"
  			}
  		]
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  	{
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  					{
  						"firstName": "P. R.",
  						"lastName": "Telles-Dias",
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  					{
  						"firstName": "S.",
  						"lastName": "Westman",
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  					{
  						"firstName": "A. E.",
  						"lastName": "Fernandez",
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  					{
  						"firstName": "M.",
  						"lastName": "Sanchez",
  						"creatorType": "author"
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  				"title": "Impressões sobre o teste rápido para o HIV entre usuários de drogas injetáveis no Brasil",
  				"date": "12/2007",
  				"publicationTitle": "Revista de Saúde Pública",
  				"volume": "41",
  				"DOI": "10.1590/S0034-89102007000900015",
  				"pages": "94-100",
  				"ISSN": "0034-8910",
  				"url": "http://www.scielosp.org/scielo.php?script=sci_abstract&pid=S0034-89102007000900015&lng=en&nrm=iso&tlng=pt",
  				"accessDate": "CURRENT_TIMESTAMP",
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  		"url": "http://www.hindawi.com/journals/mpe/2013/868174/abs/",
  		"items": [
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  				"creators": [
  					{
  						"firstName": "Guoqiang",
  						"lastName": "Wu",
  						"creatorType": "author"
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  					{
  						"firstName": "Jianwei",
  						"lastName": "Zhang",
  						"creatorType": "author"
  					},
  					{
  						"firstName": "Yuguang",
  						"lastName": "Bai",
  						"creatorType": "author"
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  				"notes": [],
  				"tags": [],
  				"seeAlso": [],
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  				"title": "Robust Filtering for Networked Stochastic Systems Subject to Sensor Nonlinearity",
  				"publicationTitle": "Mathematical Problems in Engineering",
  				"volume": "2013",
  				"publisher": "Hindawi Publishing Corporation",
  				"institution": "Hindawi Publishing Corporation",
  				"company": "Hindawi Publishing Corporation",
  				"label": "Hindawi Publishing Corporation",
  				"distributor": "Hindawi Publishing Corporation",
  				"date": "2013/02/20",
  				"ISSN": "1024-123X",
  				"reportType": "Research article",
  				"letterType": "Research article",
  				"manuscriptType": "Research article",
  				"mapType": "Research article",
  				"thesisType": "Research article",
  				"websiteType": "Research article",
  				"presentationType": "Research article",
  				"postType": "Research article",
  				"audioFileType": "Research article",
  				"language": "en",
  				"extra": "The problem of network-based robust filtering for stochastic systems with sensor nonlinearity is investigated in this paper. In the network environment, the effects of the sensor saturation, output quantization, and network-induced delay are taken into simultaneous consideration, and the output measurements received in the filter side are incomplete. The random delays are modeled as a linear function of the stochastic variable described by a Bernoulli random binary distribution. The derived criteria for performance analysis of the filtering-error system and filter design are proposed which can be solved by using convex optimization method. Numerical examples show the effectiveness of the design method.",
  				"abstractNote": "The problem of network-based robust filtering for stochastic systems with sensor nonlinearity is investigated in this paper. In the network environment, the effects of the sensor saturation, output quantization, and network-induced delay are taken into simultaneous consideration, and the output measurements received in the filter side are incomplete. The random delays are modeled as a linear function of the stochastic variable described by a Bernoulli random binary distribution. The derived criteria for performance analysis of the filtering-error system and filter design are proposed which can be solved by using convex optimization method. Numerical examples show the effectiveness of the design method.",
  				"DOI": "10.1155/2013/868174",
  				"url": "http://www.hindawi.com/journals/mpe/2013/868174/abs/",
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leafName: Library Catalog (BiblioCommons).js
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leafName: Sueddeutsche.de.js
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leafName: Sydney Morning Herald.js
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leafName: Talis Aspire.js
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leafName: TalisPrism.js
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leafName: Tatar zamanı.js
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leafName: Tatpressa.ru.js
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leafName: Taylor and Francis+NEJM.js
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leafName: taz.de.js
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leafName: TEI.js
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leafName: The Age.js
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leafName: The Atlantic.js
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leafName: The Australian.js
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leafName: The Boston Globe.js
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leafName: The Chronicle of Higher Education.js
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leafName: The Daily Beast.js
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leafName: The Economist.js
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leafName: The Guardian.js
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leafName: The Hamilton Spectator.js
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leafName: The Hindu (old).js
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leafName: The Hindu.js
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leafName: The Microfinance Gateway.js
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leafName: The Nation.js
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leafName: The New Republic.js
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leafName: The New York Review of Books.js
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leafName: The Open Library.js
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leafName: The Telegraph.js
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leafName: The Times and Sunday Times.js
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leafName: Theory of Computing.js
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leafName: Time.com.js
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leafName: Toronto Star.js
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leafName: Treesearch.js
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leafName: TV by the Numbers.js
translatorJSON:
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leafName: TVNZ.js
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leafName: Twitter.js
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leafName: unAPI.js
translatorJSON:
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code:
  {
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  	"label": "unAPI",
  	"creator": "Simon Kornblith",
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  }

  var RECOGNIZABLE_FORMATS = ["rdf_zotero", "rdf_bibliontology", "mods", "marc", "unimarc", "ris",
  	"refer", "bibtex", "rdf_dc"];
  var FORMAT_GUIDS = {
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  	"rdf_bibliontology":"14763d25-8ba0-45df-8f52-b8d1108e7ac9",
  	"mods":"0e2235e7-babf-413c-9acf-f27cce5f059c",
  	"marc":"a6ee60df-1ddc-4aae-bb25-45e0537be973",
  	"unimarc":"a6ee60df-1ddc-4aae-bb25-45e0537be973",
  	"ris":"32d59d2d-b65a-4da4-b0a3-bdd3cfb979e7",
  	"refer":"881f60f2-0802-411a-9228-ce5f47b64c7d",
  	"bibtex":"9cb70025-a888-4a29-a210-93ec52da40d4",
  	"rdf_dc":"5e3ad958-ac79-463d-812b-a86a9235c28f"
  };

  var unAPIResolver = false;
  var defaultFormat, unAPIIDs;

  /**
   * A class to describe an unAPI format description
   * @property isSupported {Boolean} Whether Zotero supports a format contained in this description
   * @property name {String} The unAPI format name, used to retrieve item descriptions
   * @property translatorID {String} The ID of the translator used to read this format
   *
   * @constructor
   * @param {String} aXML unAPI format description XML
   */
  UnAPIFormat = function(aXML) {
  	var parser = new DOMParser();
  	var doc = parser.parseFromString(aXML.replace(/<!DOCTYPE[^>]*>/, "").replace(/<\?xml[^>]*\?>/, ""), "text/xml");
  	
  	var foundFormat = new Object();
  	
  	// Loop through to determine format name
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  	var nNodes = nodes.length;
  	if(!nNodes) {
  		// Hack to fix for Firefox 10/Zotero 3.0.1
  		var i = 0;
  		while(i in nodes) nNodes = ++i;
  	}
  	var node, name, lowerName, format;
  	for(var i=0; i<nNodes; i++) {
  		node = nodes[i];
  		name = node.getAttribute("name");
  		lowerName = name.toLowerCase();
  		format = false;
  		
  		// Look for formats we can recognize
  		if(["rdf_zotero", "rdf_bibliontology", "bibtex", "endnote", "rdf_dc"].indexOf(lowerName) != -1) {
  			format = lowerName;
  		} else if(lowerName == "rdf_bibliontology") {
  			format = "rdf_bibliontology";
  		} else if(lowerName === "mods"
  				|| node.getAttribute("namespace_uri") === "http://www.loc.gov/mods/v3"
  				|| node.getAttribute("docs") === "http://www.loc.gov/standards/mods/"
  				|| node.getAttribute("type") === "application/mods+xml") {
  			format = "mods";
  		} else if(lowerName.match(/^marc\b/)
  				|| node.getAttribute("type") === "application/marc") {
  			format = "marc";
  		} else if(lowerName.match(/^unimarc\b/)
  				|| node.getAttribute("type") === "application/unimarc") {
  			format = "unimarc";
  		} else if(node.getAttribute("docs") == "http://www.refman.com/support/risformat_intro.asp"
  				|| lowerName.match(/^ris\b/)) {
  			format = "ris";
  		}
  		
  		if(format) foundFormat[format] = name;
  	}
  	
  	// Loop through again to determine optimal supported format
  	for(var i=0; i<RECOGNIZABLE_FORMATS.length; i++) {
  		if(foundFormat[RECOGNIZABLE_FORMATS[i]]) {
  			this.isSupported = true;
  			this.name = foundFormat[RECOGNIZABLE_FORMATS[i]];
  			this.translatorID = FORMAT_GUIDS[RECOGNIZABLE_FORMATS[i]];
  			return;
  		}
  	}
  	
  	this.isSupported = false;
  }

  /**
   * A class encapsulating an UnAPI ID
   * @property format {UnAPIFormat} Information regarding the format
   * @property items {Zotero.Item[]} Items corresponding to this ID
   *
   * @constructor
   * @param {String} id The ID contained in an abbr tag
   */
  UnAPIID = function(id) {
  	this.id = id;
  	unAPIIDs[id] = this;
  }

  UnAPIID.prototype = {
  	/**
  	 * Gets the item type for this item
  	 * @param {Function} callback Callback to be passed itemType when it is known
  	 */
  	"getItemType":function(callback) {
  		var me = this;
  		this.getItems(function(items) {
  			if(items.length === 0) {
  				callback(false);
  			} else if(items.length === 1) {
  				callback(items[0].itemType);
  			} else {
  				callback("multiple");
  			}
  		});
  	},
  	
  	/**
  	 * Gets items associated with this ID
  	 * @param {Function} callback Callback to be passed items when they have been retrieved
  	 */
  	"getItems":function(callback) {
  		if(this.items) {
  			callback(this.items);
  			return;
  		}
  		
  		var me = this;
  		this.items = [];
  		this.isSupported(function(isSupported) {
  			if(!isSupported) {
  				callback([]);
  				return;
  			}
  			
  			Zotero.Utilities.HTTP.doGet(unAPIResolver+"?id="+me.id+"&format="+me.format.name, function(text) {
  				var translator = Zotero.loadTranslator("import");
  				translator.setTranslator(me.format.translatorID);
  				translator.setString(text);
  				translator.setHandler("itemDone", function(obj, item) {
  					// add item to array
  					me.items.push(item);
  				});
  				translator.setHandler("done", function(obj) {
  					// run callback on item array
  					callback(me.items);
  				});
  				try {
  					translator.translate();
  				} catch(e) {
  					Zotero.debug("unAPI: Could not parse "+me.format.name+" metadata for ID "+me.id+": "+e);
  					callback(me.items);
  				}
  			});
  		});
  	},
  	
  	/**
  	 * Determines whether Zotero can handle this ID
  	 * @param {Function} callback Callback to be passed isSupported when it is known
  	 */
  	"isSupported":function(callback) {
  		if(this.hasOwnProperty("format")) {
  			callback(this.format.isSupported);
  			return;
  		}
  		
  		var me = this;
  		
  		getDefaultFormat(function(defaultFormat) {
  			// first try default format, since this won't require >1 HTTP request
  			if(defaultFormat.isSupported) {
  				me.format = defaultFormat;
  				callback(true);
  			} else {
  				// if no supported default format, try format for this item
  				Zotero.Utilities.HTTP.doGet(unAPIResolver+"?id="+me.id, function(text) {
  					me.format = new UnAPIFormat(text);
  					callback(!!me.format.isSupported);
  				});
  			}
  		});
  	}
  }

  /**
   * This and the x: prefix in the XPath are to work around an issue with pages
   * served as application/xhtml+xml
   *
   * https://developer.mozilla.org/en/Introduction_to_using_XPath_in_JavaScript#Implementing_a_default_namespace_for_XML_documents
   */
  function nsResolver() {
  	return 'http://www.w3.org/1999/xhtml';
  }

  /**
   * Extracts UnAPIIDs from a document
   * @param {document} A document object from which to extract unAPIIds
   * @return {UnAPIID[]} The unAPI ID objects extracted from the document
   */
  function getUnAPIIDs(doc) {
  	// look for a resolver
  	var newUnAPIResolver = doc.evaluate('//x:link[@rel="unapi-server"]', doc, nsResolver, XPathResult.ANY_TYPE, null).iterateNext();
  	if(!newUnAPIResolver) return [];
  	newUnAPIResolver = newUnAPIResolver.getAttribute("href");
  	if(unAPIResolver !== newUnAPIResolver) {
  		// if unAPI resolver has changed, clear
  		defaultFormat = false;
  		unAPIResolver = newUnAPIResolver;
  		unAPIIDs = [];
  	}
  	
  	// look for abbrs
  	var abbrs = doc.evaluate('//x:abbr[contains(@class, " unapi-id") or contains(@class, "unapi-id ") or @class="unapi-id"][@title]',
  		doc, nsResolver, XPathResult.ANY_TYPE, null);
  	var abbr;
  	var ids = [];
  	while(abbr = abbrs.iterateNext()) {
  		var id = abbr.getAttribute("title");
  		ids.push(unAPIIDs[id] ? unAPIIDs[id] : new UnAPIID(id));
  	}
  	
  	return ids;
  }


  /**
   * Retrieves the list of formats available for all items accessible through this unAPI resolver
   * @param {Function} callback A callback to be passed the format when it is available
   */
  function getDefaultFormat(callback) {
  	if(defaultFormat) {
  		callback(defaultFormat);
  	} else {
  		Zotero.Utilities.HTTP.doGet(unAPIResolver, function(text) {
  			// determine format of this item
  			defaultFormat = new UnAPIFormat(text);
  			callback(defaultFormat);
  		});
  	}
  }
  /**
   * Determines itemType for detection
   */
  function determineDetectItemType(ids, supportedId) {
  	var id = ids.shift();
  	id.isSupported(function(isSupported) {
  		if(isSupported && supportedId !== undefined) {
  			// If there are multiple items with valid itemTypes, use "multiple"
  			Zotero.done("multiple");
  		} else if(ids.length) {
  			// If IDs remain to be handled, handle the next one
  			determineDetectItemType(ids, (isSupported ? id : supportedId));
  		} else {
  			// If all IDs have been handled, get foundItemType for only supported ID
  			if(isSupported) {
  				id.getItemType(Zotero.done);
  			} else {
  				Zotero.done(false);
  			}
  		}
  	});
  }

  /**
   * Get all items
   * @param {UnAPIID[]} ids List of UnAPI IDs
   * @param {Function} callback Function to pass item array to when items have been retrieved
   * @param {Zotero.Item[]} items Item array; used for recursive calls
   **/
  function getAllItems(ids, callback, items) {
  	var id = ids.shift();
  	id.getItems(function(retrievedItems) {
  		var collectedItems = (items ? items.concat(retrievedItems) : retrievedItems);
  		
  		if(ids.length) {
  			getAllItems(ids, callback, collectedItems);
  		} else {
  			callback(collectedItems);
  		}
  	});
  }

  function detectWeb(doc, url) {
  	// get unAPI IDs
  	var ids = getUnAPIIDs(doc);
  	if(!ids.length) return false;
  	
  	// now we need to see if the server actually gives us bibliographic metadata, and determine the
  	// type
  	Zotero.wait();
  	
  	if(!ids.length === 1) {
  		// Only one item, so we will just get its item type
  		ids[0].getItemType(Zotero.done);
  	} else {
  		// Several items. We will need to call determineDetectItemType
  		determineDetectItemType(ids);
  	}
  }

  function doWeb(doc, url) {
  	var ids = getUnAPIIDs(doc);
  	
  	Zotero.wait();
  	
  	getAllItems(ids, function(items) {
  		// get the domain we're scraping, so we can use it for libraryCatalog
  		domain = doc.location.href.match(/https?:\/\/([^/]+)/);
  		
  		if(items.length == 1) {
  			// If only one item, just complete it
  			items[0].libraryCatalog = domain[1];
  			items[0].complete();
  		} else if(items.length > 0) {
  			// If multiple items, extract their titles
  			var itemTitles = [];
  			for(var i in items) {
  				itemTitles[i] = items[i].title;
  			}
  			
  			// Show item selection dialog
  			var chosenItems = Zotero.selectItems(itemTitles);
  			if(!chosenItems) Zotero.done(true);
  			
  			// Complete items
  			for(var i in chosenItems) {
  				items[i].libraryCatalog = domain[1];
  				items[i].complete();
  			}
  		}
  		
  		Zotero.done();
  		return;
  	});
  }


  /** BEGIN TEST CASES **/
  var testCases = [
  	{
  		"type": "web",
  		"url": "http://search.library.utoronto.ca/UTL/index?N=0&Ntk=Anywhere&Ntt=nimni+challenge+of+post-zionism&Ntx=mode%2Bmatchallpartial&Nu=p_work_normalized&Np=1&formName=search_form_simple",
  		"items": [
  			{
  				"itemType": "book",
  				"creators": [
  					{
  						"lastName": "Nimni",
  						"firstName": "Ephraim.",
  						"creatorType": "seriesEditor"
  					}
  				],
  				"notes": [],
  				"tags": [
  					"Post-Zionism.",
  					"Zionism -- Philosophy.",
  					"National characteristics, Israeli.",
  					"Israel -- Politics and government."
  				],
  				"seeAlso": [],
  				"attachments": [],
  				"title": "The challenge of Post-Zionism : alternatives to Israeli fundamentalist politics",
  				"publisher": "Zed Books",
  				"place": "New York",
  				"ISBN": "185649893X",
  				"url": "http://www.loc.gov/catdir/description/hol032/2002190908.html",
  				"date": "2003",
  				"libraryCatalog": "search.library.utoronto.ca",
  				"accessDate": "CURRENT_TIMESTAMP",
  				"shortTitle": "The challenge of Post-Zionism"
  			}
  		]
  	},
  	{
  		"type": "web",
  		"url": "http://search8.library.utoronto.ca/UTL/index?N=0&Ntk=Anywhere&Ntt=adam+smith&Ntx=mode%2Bmatchallpartial&Nu=p_work_normalized&Np=1&formName=search_form_simple",
  		"items": "multiple"
  	}
  ]
  /** END TEST CASES **/


leafName: UPCommons.js
translatorJSON:
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  	"translatorType": 4,
  	"label": "UPCommons",
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leafName: UpToDate References.js
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leafName: Vanderbilt eJournals.js
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  	"label": "Vanderbilt eJournals",
  	"creator": "Michael Berkowitz and Aurimas Vinckevicius",
  	"target": "http://ejournals.library.vanderbilt.edu/",
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leafName: Vimeo.js
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leafName: Wall Street Journal.js
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leafName: Wanfang Data.js
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leafName: washingtonpost.com.js
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leafName: Welt Online.js
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leafName: Wikimedia Commons.js
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leafName: Wikipedia Citation Templates.js
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  	"lastUpdated": "2014-01-12 09:10:00"
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